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Bonivento C, Kambeitz-Ilankovic L, Maggioni E, Borgwardt S, Lencer R, Meisenzahl E, Kambeitz J, Ruhrmann S, Salokangas RKR, Bertolino A, Stainton A, Wenzel J, Pantelis C, Wood SJ, Upthegrove R, Koutsouleris N, Brambilla P. Neurocognitive skills and vulnerability for psychosis in depression and across the psychotic spectrum: findings from the PRONIA Consortium - CORRIGENDUM. Br J Psychiatry 2024; 224:185. [PMID: 38497099 DOI: 10.1192/bjp.2024.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
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Meisenzahl E, Wege N, Stegmüller V, Schulte-Körne G, Greimel E, Dannlowski U, Hahn T, Romer G, Romanos M, Deserno L, Klingele C, Theisen C, Kieckhäfer C, Forstner A, Ruhrmann S, Schultze-Lutter F. Clinical high risk state of major depressive episodes: Assessment of prodromal phase, its occurrence, duration and symptom patterns by the instrument the DEpression Early Prediction-INventory (DEEP-IN). J Affect Disord 2024; 351:403-413. [PMID: 38181843 DOI: 10.1016/j.jad.2023.12.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND To decrease the incidence of major depressive episodes, indicated prevention that targets clinical high-risk individuals with first detectable signs that forecast mental disorder is a highly relevant topic of preventive psychiatry. Still little is known about the prodrome of MDE. The aim of the current study was to identify the occurrence of a clinical high-risk state of depression, its duration and symptom constellation. METHODS Seventy-three patients with a diagnosed affective disorder in partial remission were assessed with our newly developed semi-structured extensive clinical instrument, the DEpression Early Prediction-INventory (DEEP-IN). Within DEEP-IN the course of prodromal symptoms was explored by using a life-chart method. RESULTS The significant majority of patients (93.2 %) reported a prodromal phase. The mean duration was 7.9 months (SD = 12.5). Within the group with an identified prodromal phase, psychopathological (95.6 %) as well as somatic symptoms (88.2 %) were reported. Somatic symptoms showed a moderate-to-strong effect of sex with higher prevalence in females than in males (97.6 % vs 73.1 %; V = 0.370). LIMITATIONS This feasibility study had only a small sample size. CONCLUSIONS The majority of patients with affective disorders reported a clinical prodromal phase with both psychopathological and somatic symptoms that developed months before the onset of the depressive episode. The development of structured instruments for the assessment of depressive risk states is a promising approach for indicated prevention of depression in the future.
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Affiliation(s)
- Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany.
| | - Natalia Wege
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Veronika Stegmüller
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ellen Greimel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Georg Romer
- Department of Child Adolescence Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Marcel Romanos
- Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Lorenz Deserno
- Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany; Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Neuroimaging Center, Technical University of Dresden, Dresden, Germany
| | - Cosima Klingele
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Christian Theisen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Carolin Kieckhäfer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Andreas Forstner
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Stefan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
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Koutsouleris N, Buciuman MO, Vetter CS, Weyer CFC, Zhutovsky P, Perdomo ST, Khuntia A, Milaneschi Y, Popovic D, Ruef A, Dwyer D, Chisholm K, Kambeitz L, Antonucci L, Ruhrmann S, Kambeitz J, Riecher-Rössler A, Upthegrove R, Salokangas R, Hietala J, Pantelis C, Lencer R, Meisenzahl E, Wood S, Brambilla P, Borgwardt S, Bertolino A, Falkai P. Distinct multimodal biological and functional profiles of symptom-based subgroups in recent-onset psychosis. Res Sq 2024:rs.3.rs-3949072. [PMID: 38559014 PMCID: PMC10980097 DOI: 10.21203/rs.3.rs-3949072/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Symptom heterogeneity characterizes psychotic disorders and hinders the delineation of underlying biomarkers. Here, we identify symptom-based subtypes of recent-onset psychosis (ROP) patients from the multi-center PRONIA (Personalized Prognostic Tools for Early Psychosis Management) database and explore their multimodal biological and functional signatures. We clustered N = 328 ROP patients based on their maximum factor scores in an exploratory factor analysis on the Positive and Negative Syndrome Scale items. We assessed inter-subgroup differences and compared to N = 464 healthy control (HC) individuals regarding gray matter volume (GMV), neurocognition, polygenic risk scores, and longitudinal functioning trajectories. Finally, we evaluated factor stability at 9- and 18-month follow-ups. A 4-factor solution optimally explained symptom heterogeneity, showing moderate longitudinal stability. The ROP-MOTCOG (Motor/Cognition) subgroup was characterized by GMV reductions within salience, control and default mode networks, predominantly throughout cingulate regions, relative to HC individuals, had the most impaired neurocognition and the highest genetic liability for schizophrenia. ROP-SOCWD (Social Withdrawal) patients showed GMV reductions within medial fronto-temporal regions of the control, default mode, and salience networks, and had the lowest social functioning across time points. ROP-POS (Positive) evidenced GMV decreases in salience, limbic and frontal regions of the control and default mode networks. The ROP-AFF (Affective) subgroup showed GMV reductions in the salience, limbic, and posterior default-mode and control networks, thalamus and cerebellum. GMV reductions in fronto-temporal regions of the salience and control networks were shared across subgroups. Our results highlight the existence of behavioral subgroups with distinct neurobiological and functional profiles in early psychosis, emphasizing the need for refined symptom-based diagnosis and prognosis frameworks.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lana Kambeitz
- University of Cologne, Faculty of Medicine and University Hospital
| | - Linda Antonucci
- Faculty of Medicine and University Hospital, University of Cologne, Cologne
| | - Stephan Ruhrmann
- Faculty of Medicine and University Hospital, University of Cologne, Cologne
| | - Joseph Kambeitz
- Faculty of Medicine and University Hospital, University of Cologne, Cologne
| | | | | | | | | | | | | | | | | | | | | | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, Aldo Moro University, Bari
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Hoheisel L, Kambeitz-Ilankovic L, Wenzel J, Haas SS, Antonucci LA, Ruef A, Penzel N, Schultze-Lutter F, Lichtenstein T, Rosen M, Dwyer DB, Salokangas RKR, Lencer R, Brambilla P, Borgwardt S, Wood SJ, Upthegrove R, Bertolino A, Ruhrmann S, Meisenzahl E, Koutsouleris N, Fink GR, Daun S, Kambeitz J. Alterations of Functional Connectivity Dynamics in Affective and Psychotic Disorders. Biol Psychiatry Cogn Neurosci Neuroimaging 2024:S2451-9022(24)00065-X. [PMID: 38461964 DOI: 10.1016/j.bpsc.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/23/2024] [Accepted: 02/15/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Psychosis and depression patients exhibit widespread neurobiological abnormalities. The analysis of dynamic functional connectivity (dFC), allows for the detection of changes in complex brain activity patterns, providing insights into common and unique processes underlying these disorders. METHODS In the present study, we report the analysis of dFC in a large patient sample including 127 clinical high-risk patients (CHR), 142 recent-onset psychosis (ROP) patients, 134 recent-onset depression (ROD) patients, and 256 healthy controls (HC). A sliding window-based technique was used to calculate the time-dependent FC in resting-state MRI data, followed by clustering to reveal recurrent FC states in each diagnostic group. RESULTS We identified five unique FC states, which could be identified in all groups with high consistency (rmean = 0.889, sd = 0.116). Analysis of dynamic parameters of these states showed a characteristic increase in the lifetime and frequency of a weakly-connected FC state in ROD patients (p < 0.0005) compared to most other groups, and a common increase in the lifetime of a FC state characterised by high sensorimotor and cingulo-opercular connectivities in all patient groups compared to the HC group (p < 0.0002). Canonical correlation analysis revealed a mode which exhibited significant correlations between dFC parameters and clinical variables (r = 0.617, p < 0.0029), which was associated with positive psychosis symptom severity and several dFC parameters. CONCLUSIONS Our findings indicate diagnosis-specific alterations of dFC and underline the potential of dynamic analysis to characterize disorders such as depression, psychosis and clinical risk states.
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Affiliation(s)
- Linnea Hoheisel
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Linda A Antonucci
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich, Germany
| | - Nora Penzel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Dominic B Dwyer
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | | | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stephan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Birmingham Early Interventions Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich, Germany
| | - Gereon R Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Silvia Daun
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Institute of Zoology, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
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Osman N, Michel C, Schimmelmann BG, Schilbach L, Meisenzahl E, Schultze-Lutter F. Pathways to professional mental care in the Swiss young adult community: a case-control study. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01757-4. [PMID: 38429553 DOI: 10.1007/s00406-024-01757-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/09/2024] [Indexed: 03/03/2024]
Abstract
Treatment success for mental health (MH) problems depends, among others, on the timeliness of help-seeking. Therefore, we studied the effect of symptoms and reasons for help-seeking on the point-of-contact and the most intensive professional treatment in a community sample. Participants were recruited as part of the 'Bern Epidemiological At-Risk' (BEAR) study on 16-40-year-old community persons of the Swiss canton Bern. Of the 2,683 participants, 615 (22.9%) reported at least one instance of help-seeking for MH problems and were selected for the presented analyses. Help-seeking behavior was assessed by a modified version of the 'WHO pathway-to-care questionnaire', from which the outcome 'most intensive MH professional contact' was generated. The effect of symptoms and reasons for help-seeking were analyzed in separate models using path analyses. Most help-seeking persons sought MH professional help (n = 405; 65.9%) with a high number of medical pre-contacts (n = 233; 37.9%). The 'most intensive MH professional contact' was provided after an average of 1.47 contacts. Both models showed negative associations between non-MH professional pre-contacts and the most intensive, likely most adequate MH treatment. In the symptom model, 'substance misuse' and 'central-vegetative problems' increased the general likelihood of MH professional contact. Our findings highlight the importance of the first point-of-contact in pathways to adequate MH care and, when seeking help from non-MH professional, of quick referrals to MH professionals. Awareness campaigns or training of health professionals, such as general practitioners, may support timely contact with MH professionals to improve diagnosis, prognosis, and outcome.
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Affiliation(s)
- N Osman
- Clinic for Psychiatry and Psychotherapy/LVR-Clinic Duesseldorf, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
| | - C Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - B G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - L Schilbach
- Clinic for Psychiatry and Psychotherapy/LVR-Clinic Duesseldorf, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Medical Faculty, Ludwig Maximilians Universität, Munich, Germany
| | - E Meisenzahl
- Clinic for Psychiatry and Psychotherapy/LVR-Clinic Duesseldorf, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - F Schultze-Lutter
- Clinic for Psychiatry and Psychotherapy/LVR-Clinic Duesseldorf, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
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Şahin D, Kambeitz-Ilankovic L, Wood S, Dwyer D, Upthegrove R, Salokangas R, Borgwardt S, Brambilla P, Meisenzahl E, Ruhrmann S, Schultze-Lutter F, Lencer R, Bertolino A, Pantelis C, Koutsouleris N, Kambeitz J. Algorithmic fairness in precision psychiatry: analysis of prediction models in individuals at clinical high risk for psychosis. Br J Psychiatry 2024; 224:55-65. [PMID: 37936347 DOI: 10.1192/bjp.2023.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Computational models offer promising potential for personalised treatment of psychiatric diseases. For their clinical deployment, fairness must be evaluated alongside accuracy. Fairness requires predictive models to not unfairly disadvantage specific demographic groups. Failure to assess model fairness prior to use risks perpetuating healthcare inequalities. Despite its importance, empirical investigation of fairness in predictive models for psychiatry remains scarce. AIMS To evaluate fairness in prediction models for development of psychosis and functional outcome. METHOD Using data from the PRONIA study, we examined fairness in 13 published models for prediction of transition to psychosis (n = 11) and functional outcome (n = 2) in people at clinical high risk for psychosis or with recent-onset depression. Using accuracy equality, predictive parity, false-positive error rate balance and false-negative error rate balance, we evaluated relevant fairness aspects for the demographic attributes 'gender' and 'educational attainment' and compared them with the fairness of clinicians' judgements. RESULTS Our findings indicate systematic bias towards assigning less favourable outcomes to individuals with lower educational attainment in both prediction models and clinicians' judgements, resulting in higher false-positive rates in 7 of 11 models for transition to psychosis. Interestingly, the bias patterns observed in algorithmic predictions were not significantly more pronounced than those in clinicians' predictions. CONCLUSIONS Educational bias was present in algorithmic and clinicians' predictions, assuming more favourable outcomes for individuals with higher educational level (years of education). This bias might lead to increased stigma and psychosocial burden in patients with lower educational attainment and suboptimal psychosis prevention in those with higher educational attainment.
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Affiliation(s)
- Derya Şahin
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; and Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany
| | - Stephen Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia; and Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Dominic Dwyer
- Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany; and Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, UK; and Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Stefan Borgwardt
- Department of Psychiatry (University Psychiatric Clinics, UPK), University of Basel, Basel, Switzerland; and Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; and University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany; and Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Nikolaos Koutsouleris
- Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany; Max-Planck Institute of Psychiatry, Munich, Germany; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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7
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Wenzel J, Badde L, Haas SS, Bonivento C, Van Rheenen TE, Antonucci LA, Ruef A, Penzel N, Rosen M, Lichtenstein T, Lalousis PA, Paolini M, Stainton A, Dannlowski U, Romer G, Brambilla P, Wood SJ, Upthegrove R, Borgwardt S, Meisenzahl E, Salokangas RKR, Pantelis C, Lencer R, Bertolino A, Kambeitz J, Koutsouleris N, Dwyer DB, Kambeitz-Ilankovic L. Transdiagnostic subgroups of cognitive impairment in early affective and psychotic illness. Neuropsychopharmacology 2024; 49:573-583. [PMID: 37737273 PMCID: PMC10789737 DOI: 10.1038/s41386-023-01729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/03/2023] [Accepted: 08/26/2023] [Indexed: 09/23/2023]
Abstract
Cognitively impaired and spared patient subgroups were identified in psychosis and depression, and in clinical high-risk for psychosis (CHR). Studies suggest differences in underlying brain structural and functional characteristics. It is unclear whether cognitive subgroups are transdiagnostic phenomena in early stages of psychotic and affective disorder which can be validated on the neural level. Patients with recent-onset psychosis (ROP; N = 140; female = 54), recent-onset depression (ROD; N = 130; female = 73), CHR (N = 128; female = 61) and healthy controls (HC; N = 270; female = 165) were recruited through the multi-site study PRONIA. The transdiagnostic sample and individual study groups were clustered into subgroups based on their performance in eight cognitive domains and characterized by gray matter volume (sMRI) and resting-state functional connectivity (rsFC) using support vector machine (SVM) classification. We identified an impaired subgroup (NROP = 79, NROD = 30, NCHR = 37) showing cognitive impairment in executive functioning, working memory, processing speed and verbal learning (all p < 0.001). A spared subgroup (NROP = 61, NROD = 100, NCHR = 91) performed comparable to HC. Single-disease subgroups indicated that cognitive impairment is stronger pronounced in impaired ROP compared to impaired ROD and CHR. Subgroups in ROP and ROD showed specific symptom- and functioning-patterns. rsFC showed superior accuracy compared to sMRI in differentiating transdiagnostic subgroups from HC (BACimpaired = 58.5%; BACspared = 61.7%, both: p < 0.01). Cognitive findings were validated in the PRONIA replication sample (N = 409). Individual cognitive subgroups in ROP, ROD and CHR are more informative than transdiagnostic subgroups as they map onto individual cognitive impairment and specific functioning- and symptom-patterns which show limited overlap in sMRI and rsFC. CLINICAL TRIAL REGISTRY NAME: German Clinical Trials Register (DRKS). Clinical trial registry URL: https://www.drks.de/drks_web/ . Clinical trial registry number: DRKS00005042.
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Affiliation(s)
- Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
| | - Luzie Badde
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, NY, USA
| | | | - Tamsyn E Van Rheenen
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
- Department of Translational Biomedicine and Neuroscience - University of Bari Aldo Moro, Bari, Italy
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Department of Translational Biomedicine and Neuroscience - University of Bari Aldo Moro, Bari, Italy
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Paris Alexandros Lalousis
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - Marco Paolini
- Department of Radiology, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Alexandra Stainton
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University of Münster, Münster, Germany
| | - Paolo Brambilla
- Department of Neuosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - Stephen J Wood
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, Birmingham, UK
- Institute of Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Stefan Borgwardt
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Western Health, Melbourne, VIC, Australia
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Muenster, Münster, Germany
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience - University of Bari Aldo Moro, Bari, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, UK
- Max Planck Institute for Psychiatry, Munich, Germany
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
- Orygen, Melbourne, VIC, Australia
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany
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8
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Kujovic M, Benz D, Riesbeck M, Bahr C, Kriegs C, Reinermann D, Jänner M, Neufang S, Margittai Z, Kamp D, Plewnia C, Meisenzahl E. Theta burst stimulation add on to dialectical behavioral therapy in borderline-personality-disorder: methods and design of a randomized, single-blind, placebo-controlled pilot trial. Eur Arch Psychiatry Clin Neurosci 2024; 274:87-96. [PMID: 37710135 PMCID: PMC10787000 DOI: 10.1007/s00406-023-01692-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
Specialized psychotherapeutic treatments like dialectical behavioral therapy (DBT) are recommended as first treatment for borderline personality disorder (BPD). In recent years, studies have emerged that focus on repetitive transcranial magnetic stimulation (rTMS) in BPD. Both have independently demonstrated efficacy in the treatment of BPD. Intermitted theta burst stimulation (iTBS), a modified design of rTMS, is thought to increase the excitability of neurons and could be a supplement to psychotherapy in addition to being a standalone treatment. However, no studies to date have investigated the combination of DBT and rTMS/iTBS. This study protocol describes the methods and design of a randomized, single-blinded, sham-controlled clinical pilot study in which BPD patients will be randomly assigned to either iTBS or sham during four consecutive weeks (20 sessions in total) in addition to standardized DBT treatment. The stimulation will focus on the unilateral stimulation of the left dorsolateral prefrontal cortex (DLPFC), which plays an important role in the control of impulsivity and risk-taking. Primary outcome is the difference in borderline symptomatology, while secondary target criteria are depressive symptoms, general functional level, impulsivity and self-compassion. Statistical analysis of therapy response will be conducted by Mixed Model Repeated Measurement using a 2 × 2-factorial between-subjects design with the between-subject factor stimulation (TMS vs. Sham) and the within-subject factor time (T0 vs. T1). Furthermore, structural magnetic resonance imaging (MRI) will be conducted and analyzed. The study will provide evidence and insight on whether iTBS has an enhancing effect as add-on to DBT in BPD.Trial registration: drks.de (DRKS00020413) registered 13/01/2020.
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Affiliation(s)
- Milenko Kujovic
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
| | - Daniel Benz
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Mathias Riesbeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Bahr
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Kriegs
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Dirk Reinermann
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Michaela Jänner
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Zsofia Margittai
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, Tübingen, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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9
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Walter N, Wenzel J, Haas SS, Squarcina L, Bonivento C, Ruef A, Dwyer D, Lichtenstein T, Bastrük Ö, Stainton A, Antonucci LA, Brambilla P, Wood SJ, Upthegrove R, Borgwardt S, Lencer R, Meisenzahl E, Salokangas RKR, Pantelis C, Bertolino A, Koutsouleris N, Kambeitz J, Kambeitz-Ilankovic L. A multivariate cognitive approach to predict social functioning in recent onset psychosis in response to computerized cognitive training. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110864. [PMID: 37717645 DOI: 10.1016/j.pnpbp.2023.110864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/01/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Abstract
Clinical and neuroimaging data has been increasingly used in recent years to disentangle heterogeneity of treatment response to cognitive training (CT) and predict which individuals may achieve the highest benefits. CT has small to medium effects on improving cognitive and social functioning in recent onset psychosis (ROP) patients, who show the most profound cognitive and social functioning deficits among psychiatric patients. We employed multivariate pattern analysis (MVPA) to investigate the potential of cognitive data to predict social functioning improvement in response to 10 h of CT in patients with ROP. A support vector machine (SVM) classifier was trained on the naturalistic data of the Personalized Prognostic Tools for Early Psychosis Management (PRONIA) study sample to predict functioning in an independent sample of 70 ROP patients using baseline cognitive data. PRONIA is a part of a FP7 EU grant program that involved 7 sites across 5 European countries, designed and conducted with the main aim of identifying (bio)markers associated with an enhanced risk of developing psychosis in order to improve early detection and prognosis. Social functioning was predicted with a balanced accuracy (BAC) of 66.4% (Sensitivity 78.8%; Specificity 54.1%; PPV 60.5%; NPV 74.1%; AUC 0.64; P = 0.01). The most frequently selected cognitive features (mean feature weights > ± 0.2) included the (1) correct number of symbol matchings within the Digit Symbol Substitution Test, (2) the number of distracting stimuli leading to an error within 300 and 200 trials in the Continuous Performance Test and (3) the dynamics of verbal fluency between 15 and 30 s within the Verbal Fluency Test, phonetic part. Next, the SVM classifier generated on the PRONIA sample was applied to the intervention sample, that obtained 54 ROP patients who were randomly assigned to a social cognitive training (SCT) or treatment as usual (TAU) group and dichotomized into good (GF-S ≥ 7) and poor (GF-S < 7) functioning patients based on their level of Global Functioning-Social (GF-S) score at follow-up (FU). By applying the initial PRONIA classifier, using out-of-sample cross-validation (OOCV) to the sample of ROP patients who have undergone the CT intervention, a BAC of 59.3% (Sensitivity 70.4%; Specificity 48.1%; PPV 57.6%; NPV 61.9%; AUC 0.63) was achieved at T0 and a BAC of 64.8% (Sensitivity 66.7%; Specificity 63.0%; PPV 64.3%; NPV 65.4%; AUC 0.66) at FU. After SCT intervention, a significant improvement in predicted social functioning values was observed in the SCT compared to TAU group (P ≤0.05; ES[Cohens' d] = 0.18). Due to a small sample size and modest variance of social functioning of the intervention sample it was not feasible to predict individual response to SCT in the current study. Our findings suggest that the use of baseline cognitive data could provide a robust individual estimate of future social functioning, while prediction of individual response to SCT using cognitive data that can be generated in the routine patient care remains to be addressed in large-scale cognitive training trials.
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Affiliation(s)
- Nina Walter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America
| | | | | | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Orygen Youth Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Öznur Bastrük
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Alexandra Stainton
- Orygen Youth Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Linda A Antonucci
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Brambilla
- Department of Neuosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - Stephen J Wood
- Orygen Youth Health, Melbourne, Australia; School of Psychology, University of Birmingham, United Kingdom; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, United Kingdom; Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Borgwardt
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Rebekka Lencer
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & NorthWestern Mental Health, Melbourne, Australia
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany; Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany.
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10
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Wen J, Nasrallah IM, Abdulkadir A, Satterthwaite TD, Yang Z, Erus G, Robert-Fitzgerald T, Singh A, Sotiras A, Boquet-Pujadas A, Mamourian E, Doshi J, Cui Y, Srinivasan D, Skampardoni I, Chen J, Hwang G, Bergman M, Bao J, Veturi Y, Zhou Z, Yang S, Dazzan P, Kahn RS, Schnack HG, Zanetti MV, Meisenzahl E, Busatto GF, Crespo-Facorro B, Pantelis C, Wood SJ, Zhuo C, Shinohara RT, Gur RC, Gur RE, Koutsouleris N, Wolf DH, Saykin AJ, Ritchie MD, Shen L, Thompson PM, Colliot O, Wittfeld K, Grabe HJ, Tosun D, Bilgel M, An Y, Marcus DS, LaMontagne P, Heckbert SR, Austin TR, Launer LJ, Espeland M, Masters CL, Maruff P, Fripp J, Johnson SC, Morris JC, Albert MS, Bryan RN, Resnick SM, Fan Y, Habes M, Wolk D, Shou H, Davatzikos C. Genomic loci influence patterns of structural covariance in the human brain. Proc Natl Acad Sci U S A 2023; 120:e2300842120. [PMID: 38127979 PMCID: PMC10756284 DOI: 10.1073/pnas.2300842120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023] Open
Abstract
Normal and pathologic neurobiological processes influence brain morphology in coordinated ways that give rise to patterns of structural covariance (PSC) across brain regions and individuals during brain aging and diseases. The genetic underpinnings of these patterns remain largely unknown. We apply a stochastic multivariate factorization method to a diverse population of 50,699 individuals (12 studies and 130 sites) and derive data-driven, multi-scale PSCs of regional brain size. PSCs were significantly correlated with 915 genomic loci in the discovery set, 617 of which are newly identified, and 72% were independently replicated. Key pathways influencing PSCs involve reelin signaling, apoptosis, neurogenesis, and appendage development, while pathways of breast cancer indicate potential interplays between brain metastasis and PSCs associated with neurodegeneration and dementia. Using support vector machines, multi-scale PSCs effectively derive imaging signatures of several brain diseases. Our results elucidate genetic and biological underpinnings that influence structural covariance patterns in the human brain.
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Affiliation(s)
- Junhao Wen
- Laboratory of AI and Biomedical Science, Department of Neurology, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA90033
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Ilya M. Nasrallah
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Department of Radiology, University of Pennsylvania, Philadelphia, PA19104
| | - Ahmed Abdulkadir
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Theodore D. Satterthwaite
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Zhijian Yang
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Guray Erus
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Timothy Robert-Fitzgerald
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Ashish Singh
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Aristeidis Sotiras
- Department of Radiology, Washington University School of Medicine, St. Louis, MO63110
| | - Aleix Boquet-Pujadas
- Biomedical Imaging Group, Department of Biomedical Engineering, École Polytechnique Fédérale de Lausanne, Lausanne1015, Switzerland
| | - Elizabeth Mamourian
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Jimit Doshi
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Yuhan Cui
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Dhivya Srinivasan
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Ioanna Skampardoni
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Jiong Chen
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Gyujoon Hwang
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Mark Bergman
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Jingxuan Bao
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA19104
| | - Yogasudha Veturi
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Zhen Zhou
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Shu Yang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA19104
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, LondonWC2R 2LS, United Kingdom
| | - Rene S. Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Hugo G. Schnack
- Department of Psychiatry, University Medical Center Utrecht, Utrecht 3584 CX Ut, Netherlands
| | - Marcus V. Zanetti
- Institute of Psychiatry, Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo05508-070, Brazil
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Heinrich Heine University, Düsseldorf40204, Germany
| | - Geraldo F. Busatto
- Institute of Psychiatry, Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo05508-070, Brazil
| | - Benedicto Crespo-Facorro
- Hospital Universitario Virgen del Rocio, School of Medicine, University of Sevilla,Sevilla41004, Spain
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Stephen J. Wood
- Orygen and the Centre for Youth Mental Health, Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Chuanjun Zhuo
- Key Laboratory of Real Tine Tracing of Brain Circuits in Psychiatry and Neurology, Department of Psychiatry, Tianjin Medical University, Tianjin300070, China
| | - Russell T. Shinohara
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Ruben C. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich 80539, Germany
| | - Daniel H. Wolf
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Andrew J. Saykin
- Indiana Alzheimer’s Disease Research Center, Department of Radiology, Indiana University School of Medicine, Indianapolis, IN46202-3082
| | - Marylyn D. Ritchie
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Li Shen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA19104
| | - Paul M. Thompson
- Imaging Genetics Center, Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA90033
| | - Olivier Colliot
- Institut du Cerveau, Sorbonne Université, Paris75013, France
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, German Center for Neurodegenerative Diseases, University Medicine Greifswald, Greifswald17475, Germany
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, German Center for Neurodegenerative Diseases, University Medicine Greifswald, Greifswald17475, Germany
| | - Duygu Tosun
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143
| | - Murat Bilgel
- Laboratory of Behavioral Neuroscience, National Institute on Aging, NIH, Baltimore21224, MD
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, NIH, Baltimore21224, MD
| | - Daniel S. Marcus
- Department of Radiology, Washington University School of Medicine, St. Louis, MO63110
| | - Pamela LaMontagne
- Department of Radiology, Washington University School of Medicine, St. Louis, MO63110
| | - Susan R. Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA98195
| | - Thomas R. Austin
- Department of Epidemiology, University of Washington, Seattle, WA98195
| | - Lenore J. Launer
- Neuroepidemiology Section, Intramural Research Program, National Institute on Aging, Washington, MD20817
| | - Mark Espeland
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Divisions of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC27101
| | - Colin L. Masters
- Florey Institute of Neuroscience and Mental Health, Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC3010, Australia
| | - Paul Maruff
- Florey Institute of Neuroscience and Mental Health, Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC3010, Australia
| | - Jurgen Fripp
- Health and Biosecurity, Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD4029, Australia
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Institute, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI53792
| | - John C. Morris
- Knight Alzheimer Disease Research Center, Department of Neurology, Washington University in St. Louis, St. Louis, MO63110
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD21205
| | - R. Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA19104
| | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, NIH, Baltimore21224, MD
| | - Yong Fan
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Mohamad Habes
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX78229
| | - David Wolk
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Department of Neurology, University of Pennsylvania, Philadelphia, PA19104
| | - Haochang Shou
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Christos Davatzikos
- AI in Biomedical Imaging Laboratory, Department of Radiology, Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
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11
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Buciuman MO, Oeztuerk OF, Popovic D, Enrico P, Ruef A, Bieler N, Sarisik E, Weiske J, Dong MS, Dwyer DB, Kambeitz-Ilankovic L, Haas SS, Stainton A, Ruhrmann S, Chisholm K, Kambeitz J, Riecher-Rössler A, Upthegrove R, Schultze-Lutter F, Salokangas RKR, Hietala J, Pantelis C, Lencer R, Meisenzahl E, Wood SJ, Brambilla P, Borgwardt S, Falkai P, Antonucci LA, Bertolino A, Liddle P, Koutsouleris N. Structural and Functional Brain Patterns Predict Formal Thought Disorder's Severity and Its Persistence in Recent-Onset Psychosis: Results From the PRONIA Study. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:1207-1217. [PMID: 37343661 DOI: 10.1016/j.bpsc.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Formal thought disorder (FThD) is a core feature of psychosis, and its severity and long-term persistence relates to poor clinical outcomes. However, advances in developing early recognition and management tools for FThD are hindered by a lack of insight into the brain-level predictors of FThD states and progression at the individual level. METHODS Two hundred thirty-three individuals with recent-onset psychosis were drawn from the multisite European Prognostic Tools for Early Psychosis Management study. Support vector machine classifiers were trained within a cross-validation framework to separate two FThD symptom-based subgroups (high vs. low FThD severity), using cross-sectional whole-brain multiband fractional amplitude of low frequency fluctuations, gray matter volume and white matter volume data. Moreover, we trained machine learning models on these neuroimaging readouts to predict the persistence of high FThD subgroup membership from baseline to 1-year follow-up. RESULTS Cross-sectionally, multivariate patterns of gray matter volume within the salience, dorsal attention, visual, and ventral attention networks separated the FThD severity subgroups (balanced accuracy [BAC] = 60.8%). Longitudinally, distributed activations/deactivations within all fractional amplitude of low frequency fluctuation sub-bands (BACslow-5 = 73.2%, BACslow-4 = 72.9%, BACslow-3 = 68.0%), gray matter volume patterns overlapping with the cross-sectional ones (BAC = 62.7%), and smaller frontal white matter volume (BAC = 73.1%) predicted the persistence of high FThD severity from baseline to follow-up, with a combined multimodal balanced accuracy of BAC = 77%. CONCLUSIONS We report the first evidence of brain structural and functional patterns predictive of FThD severity and persistence in early psychosis. These findings open up avenues for the development of neuroimaging-based diagnostic, prognostic, and treatment options for the early recognition and management of FThD and associated poor outcomes.
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Affiliation(s)
- Madalina-Octavia Buciuman
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany
| | - Oemer Faruk Oeztuerk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany
| | - Paolo Enrico
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Nadia Bieler
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Elif Sarisik
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany
| | - Johanna Weiske
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Mark Sen Dong
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra Stainton
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | | | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | | | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Carlton South, Melbourne, Victoria, Australia; NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Stephen J Wood
- Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia; School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lüebeck, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany
| | - Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy; Department of Translational Biomedicine and Neuroscience (DiBraiN) - University of Bari "Aldo Moro," Bari, Italy
| | - Peter Liddle
- Division of Mental Health and Clinical Neuroscience, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
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Schultze-Lutter F, Meisenzahl E. The clinical high-risk of psychosis approach as an emerging model for precision prevention in psychiatry. Eur Neuropsychopharmacol 2023; 76:17-19. [PMID: 37451162 DOI: 10.1016/j.euroneuro.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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13
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Stainton A, Chisholm K, Griffiths SL, Kambeitz-Ilankovic L, Wenzel J, Bonivento C, Brambilla P, Iqbal M, Lichtenstein TK, Rosen M, Antonucci LA, Maggioni E, Kambeitz J, Borgwardt S, Riecher-Rössler A, Andreou C, Schmidt A, Schultze-Lutter F, Meisenzahl E, Ruhrmann S, Salokangas RKR, Pantelis C, Lencer R, Romer G, Bertolino A, Upthegrove R, Koutsouleris N, Allott K, Wood SJ. Prevalence of cognitive impairments and strengths in the early course of psychosis and depression. Psychol Med 2023; 53:5945-5957. [PMID: 37409883 PMCID: PMC10520593 DOI: 10.1017/s0033291723001770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/12/2023] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Studies investigating cognitive impairments in psychosis and depression have typically compared the average performance of the clinical group against healthy controls (HC), and do not report on the actual prevalence of cognitive impairments or strengths within these clinical groups. This information is essential so that clinical services can provide adequate resources to supporting cognitive functioning. Thus, we investigated this prevalence in individuals in the early course of psychosis or depression. METHODS A comprehensive cognitive test battery comprising 12 tests was completed by 1286 individuals aged 15-41 (mean age 25.07, s.d. 5.88) from the PRONIA study at baseline: HC (N = 454), clinical high risk for psychosis (CHR; N = 270), recent-onset depression (ROD; N = 267), and recent-onset psychosis (ROP; N = 295). Z-scores were calculated to estimate the prevalence of moderate or severe deficits or strengths (>2 s.d. or 1-2 s.d. below or above HC, respectively) for each cognitive test. RESULTS Impairment in at least two cognitive tests was as follows: ROP (88.3% moderately, 45.1% severely impaired), CHR (71.2% moderately, 22.4% severely impaired), ROD (61.6% moderately, 16.2% severely impaired). Across clinical groups, impairments were most prevalent in tests of working memory, processing speed, and verbal learning. Above average performance (>1 s.d.) in at least two tests was present for 40.5% ROD, 36.1% CHR, 16.1% ROP, and was >2 SDs in 1.8% ROD, 1.4% CHR, and 0% ROP. CONCLUSIONS These findings suggest that interventions should be tailored to the individual, with working memory, processing speed, and verbal learning likely to be important transdiagnostic targets.
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Affiliation(s)
- Alexandra Stainton
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Siân Lowri Griffiths
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Mariam Iqbal
- Department of Psychology, Woodbourne Priory Hospital, Birmingham, UK
| | - Theresa K. Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Linda A. Antonucci
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari “Aldo Moro”, Bari, Italy
| | - Eleonora Maggioni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | | | - Christina Andreou
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - André Schmidt
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Georg Romer
- Department of Child Adolescent Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari “Aldo Moro”, Bari, Italy
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Women's and Children NHS Foundation Trust, Birmingham, UK
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck Institute of Psychiatry, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kelly Allott
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J. Wood
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
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Bonivento C, Kambeitz-Ilankovic L, Maggioni E, Borgwardt S, Lencer R, Meisenzahl E, Kambeitz J, Ruhrmann S, Salokangas RKR, Bertolino A, Stainton A, Wenzel J, Pantelis C, Wood SJ, Upthegrove R, Koutsouleris N, Brambilla P. Neurocognitive skills and vulnerability for psychosis in depression and across the psychotic spectrum: findings from the PRONIA Consortium. Br J Psychiatry 2023; 223:485-492. [PMID: 37846967 DOI: 10.1192/bjp.2023.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND Neurocognitive deficits are a core feature of psychosis and depression. Despite commonalities in cognitive alterations, it remains unclear if and how the cognitive deficits in patients at clinical high risk for psychosis (CHR) and those with recent-onset psychosis (ROP) are distinct from those seen in recent-onset depression (ROD). AIMS This study was carried out within the European project 'Personalized Prognostic Tools for Early Psychosis Management', and aimed to characterise the cognitive profiles of patients with psychosis or depression. METHOD We examined cognitive profiles for patients with ROP (n = 105), patients with ROD (n = 123), patients at CHR (n = 116) and healthy controls (n = 372) across seven sites in five European countries. Confirmatory factor analysis identified four cognitive factors independent of gender, education and site: speed of processing, attention and working memory, verbal learning and spatial learning. RESULTS Patients with ROP performed worse than healthy controls in all four domains (P < 0.001), whereas performance of patients with ROD was not affected (P > 0.05). Patients at CHR performed worse than healthy controls in speed of processing (P = 0.001) and spatial learning (P = 0.003), but better than patients with ROP across all cognitive domains (all P ≤ 0.01). CHR and ROD groups did not significantly differ in any cognitive domain. These findings were independent of comorbid depressive symptoms, substance consumption and illness duration. CONCLUSIONS These results show that neurocognitive abilities are affected in CHR and ROP, whereas ROD seems spared. Although our findings may support the notion that those at CHR have a specific vulnerability to psychosis, future studies investigating broader transdiagnostic risk cohorts in longitudinal designs are needed.
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Affiliation(s)
| | - Lana Kambeitz-Ilankovic
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany; and Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Germany
| | - Eleonora Maggioni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | - Stefan Borgwardt
- Translational Psychiatry Unit, Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Rebekka Lencer
- Institute for Translational Psychiatry, Münster University, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Germany
| | - Joseph Kambeitz
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany; and Cognitive Neuroscience (INM-3), Institute of Neuroscience and Medicine, Research Center Jülich, Germany
| | - Stephan Ruhrmann
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
| | | | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Italy
| | - Alexandra Stainton
- Orygen, Melbourne, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | - Julian Wenzel
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Australia
| | - Stephen J Wood
- Orygen, Melbourne, Australia; School of Psychology, University of Birmingham, UK; and Centre for Youth Mental Health, University of Melbourne, Australia
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, UK; Institute for Mental Health, University of Birmingham, UK; and Centre for Human Brain Health, University of Birmingham, UK
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Germany; Max Planck Institute for Psychiatry, Germany; and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Italy
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15
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Ascone L, Rohenkohl AC, Hurlemann R, Meisenzahl E, Riedel-Heller SG, Becker T, Bajbouj M, von Lilienfeld-Toal M, Gallinat J, Lambert M. [Assessment of Direct (COVID-19-Related) and Collateral, Psychosocial Pandemic Consequences for Vulnerable Groups by the Example of Serious Mental Illness]. Psychiatr Prax 2023; 50:381-388. [PMID: 37137325 PMCID: PMC10567134 DOI: 10.1055/a-2051-7613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/24/2023] [Indexed: 05/05/2023]
Abstract
The indirect pandemic consequences could by far exceed the direct effects of SARS-CoV-2 in terms of costs, morbidity, and mortality. This essay includes a proposed method (matrix) to visualize virus-related and psychosocial risks for different populations side by side in a systematic and concise manner. COVID-19-related and psychosocial vulnerability, stressors, direct and indirect consequences are derived on a theoretical and empirical basis. An exemplary quantification of the matrix for the vulnerable group of people with severe mental illness revealed a very high risk for severe COVID-19 consequences, as well as a pronounced risk for psychosocial collateral effects. The proposed approach could be further discussed for a risk-graded pandemic management, crisis recovery, and future preparedness to adequately address psychosocial collateral effects and better identify and protect vulnerable groups in this regard.
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Affiliation(s)
- Leonie Ascone
- Zentrum für Psychosoziale Medizin, Klinik und Poliklinik
für Psychiatrie und Psychotherapie, Universitätsklinikum
Hamburg-Eppendorf, Hamburg
| | - Anja Christine Rohenkohl
- Zentrum für Psychosoziale Medizin, Klinik und Poliklinik
für Psychiatrie und Psychotherapie, Universitätsklinikum
Hamburg-Eppendorf, Hamburg
| | - René Hurlemann
- Universitätsklinik für Psychiatrie und Psychotherapie,
Carl von Ossietzky Universität Oldenburg
| | - Eva Meisenzahl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der
Heinrich-Heine-Universität/ LVR Klinikum
Düsseldorf
| | - Steffi G. Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health
(ISAP), Universität Leipzig, Medizinische Fakultät,
Leipzig
| | - Thomas Becker
- Klinik und Poliklinik für Psychiatrie und Psychotherapie,
Universitätsklinikum Leipzig
| | - Malek Bajbouj
- Klinik und Hochschulambulanz für Psychiatrie, Charité
Universitätsmedizin Berlin, Klinik für Psychiatrie und
Psychotherapie Campus Benjamin Franklin, Berlin
| | - Marie von Lilienfeld-Toal
- Hämatologie und internistische Onkologie,
Universitätsklinikum Jena
- Infektionen in der Hämatologie/Onkologie,
Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie e.V.
Hans-Knöll-Institut, Jena
| | - Jürgen Gallinat
- Zentrum für Psychosoziale Medizin, Klinik und Poliklinik
für Psychiatrie und Psychotherapie, Universitätsklinikum
Hamburg-Eppendorf, Hamburg
| | - Martin Lambert
- Zentrum für Psychosoziale Medizin, Klinik und Poliklinik
für Psychiatrie und Psychotherapie, Universitätsklinikum
Hamburg-Eppendorf, Hamburg
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16
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Wagner E, Strube W, Görlitz T, Aksar A, Bauer I, Campana M, Moussiopoulou J, Hapfelmeier A, Wagner P, Egert-Schwender S, Bittner R, Eckstein K, Nenadić I, Kircher T, Langguth B, Meisenzahl E, Lambert M, Neff S, Malchow B, Falkai P, Hirjak D, Böttcher KT, Meyer-Lindenberg A, Blankenstein C, Leucht S, Hasan A. Effects of Early Clozapine Treatment on Remission Rates in Acute Schizophrenia (The EARLY Trial): Protocol of a Randomized-Controlled Multicentric Trial. Pharmacopsychiatry 2023; 56:169-181. [PMID: 37506738 PMCID: PMC10484642 DOI: 10.1055/a-2110-4259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/15/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Quick symptomatic remission after the onset of psychotic symptoms is critical in schizophrenia treatment, determining the subsequent disease course and recovery. In this context, only every second patient with acute schizophrenia achieves symptomatic remission within three months of initiating antipsychotic treatment. The potential indication extension of clozapine-the most effective antipsychotic-to be introduced at an earlier stage (before treatment-resistance) is supported by several lines of evidence, but respective clinical trials are lacking. METHODS Two hundred-twenty patients with acute non-treatment-resistant schizophrenia will be randomized in this double-blind, 8-week parallel-group multicentric trial to either clozapine or olanzapine. The primary endpoint is the number of patients in symptomatic remission at the end of week 8 according to international consensus criteria ('Andreasen criteria'). Secondary endpoints and other assessments comprise a comprehensive safety assessment (i. e., myocarditis screening), changes in psychopathology, global functioning, cognition, affective symptoms and quality of life, and patients' and relatives' views on treatment. DISCUSSION This multicentre trial aims to examine whether clozapine is more effective than a highly effective second-generation antipsychotics (SGAs), olanzapine, in acute schizophrenia patients who do not meet the criteria for treatment-naïve or treatment-resistant schizophrenia. Increasing the likelihood to achieve symptomatic remission in acute schizophrenia can improve the overall outcome, reduce disease-associated burden and potentially prevent mid- and long-term disease chronicity.
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Affiliation(s)
- Elias Wagner
- Department of Psychiatry and Psychotherapy, LMU University Hospital,
LMU Munich, Munich, Germany
| | - Wolfgang Strube
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical
Faculty, University of Augsburg, Augsburg, Germany
| | - Thomas Görlitz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical
Faculty, University of Augsburg, Augsburg, Germany
| | - Aslihan Aksar
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical
Faculty, University of Augsburg, Augsburg, Germany
| | - Ingrid Bauer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical
Faculty, University of Augsburg, Augsburg, Germany
| | - Mattia Campana
- Department of Psychiatry and Psychotherapy, LMU University Hospital,
LMU Munich, Munich, Germany
| | - Joanna Moussiopoulou
- Department of Psychiatry and Psychotherapy, LMU University Hospital,
LMU Munich, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of AI and Informatics in Medicine, School of Medicine,
Technical University of Munich, Munich, Germany
- Institute of General Practice and Health Services Research, School of
Medicine, Technical University of Munich, Munich, Germany
| | - Petra Wagner
- Münchner Studienzentrum, Technical University of Munich, School
of Medicine, Munich, Germany
| | - Silvia Egert-Schwender
- Münchner Studienzentrum, Technical University of Munich, School
of Medicine, Munich, Germany
| | - Robert Bittner
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy,
University Hospital Frankfurt, Frankfurt, Germany
| | - Kathrin Eckstein
- Clinic for Psychiatry and Psychotherapy, University of
Tübingen, Tübingen, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps-University
Marburg, Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University
Marburg, Marburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg,
Regensburg, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, LVR-Klinikum
Düsseldorf, Kliniken der Heinrich-Heine-Universität
Düsseldorf, Düsseldorf, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial
Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg,
Germany
| | - Sigrid Neff
- Department of Psychiatry and Psychotherapy 1 und 2,
Rheinhessen-Fachklinik Alzey, Academic Hospital of the University of Mainz,
Alzey, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center
Göttingen, Göttingen, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital,
LMU Munich, Munich, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental
Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Kent-Tjorben Böttcher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental
Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental
Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Christiane Blankenstein
- Münchner Studienzentrum, Technical University of Munich, School
of Medicine, Munich, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of
Munich, School of Medicine, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical
Faculty, University of Augsburg, Augsburg, Germany
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17
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Theisen C, Rosen M, Meisenzahl E, Koutsouleris N, Lichtenstein T, Ruhrmann S, Kambeitz J, Kambeitz-Ilankovic L, Riecher-Rössler A, Chisholm K, Upthegrove R, Antonucci LA, Bertolino A, Pigoni A, Salokangas RKR, Pantelis C, Wood SJ, Lencer R, Falkai P, Hietala J, Brambilla P, Schmidt A, Andreou C, Borgwardt S, Osman N, Schultze-Lutter F. The heterogeneity of attenuated and brief limited psychotic symptoms: association of contents with age, sex, country, religion, comorbidities, and functioning. Front Psychiatry 2023; 14:1209485. [PMID: 37484669 PMCID: PMC10361815 DOI: 10.3389/fpsyt.2023.1209485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The Attenuated Psychosis Symptoms (APS) syndrome mostly represents the ultra-high-risk state of psychosis but, as does the Brief Intermittent Psychotic Symptoms (BIPS) syndrome, shows a large variance in conversion rates. This may be due to the heterogeneity of APS/BIPS that may be related to the effects of culture, sex, age, and other psychiatric morbidities. Thus, we investigated the different thematic contents of APS and their association with sex, age, country, religion, comorbidity, and functioning to gain a better understanding of the psychosis-risk syndrome. Method A sample of 232 clinical high-risk subjects according to the ultra-high risk and basic symptom criteria was recruited as part of a European study conducted in Germany, Italy, Switzerland, and Finland. Case vignettes, originally used for supervision of inclusion criteria, were investigated for APS/BIPS contents, which were compared for sex, age, country, religion, functioning, and comorbidities using chi-squared tests and regression analyses. Result We extracted 109 different contents, mainly of APS (96.8%): 63 delusional, 29 hallucinatory, and 17 speech-disorganized contents. Only 20 contents (18.3%) were present in at least 5% of the sample, with paranoid and referential ideas being the most frequent. Thirty-one (28.5%) contents, in particular, bizarre ideas and perceptual abnormalities, demonstrated an association with age, country, comorbidity, or functioning, with regression models of country and obsessive-compulsive disorders explaining most of the variance: 55.8 and 38.3%, respectively. Contents did not differ between religious groups. Conclusion Psychosis-risk patients report a wide range of different contents of APS/BIPS, underlining the psychopathological heterogeneity of this group but also revealing a potential core set of contents. Compared to earlier reports on North-American samples, our maximum prevalence rates of contents were considerably lower; this likely being related to a stricter rating of APS/BIPS and cultural influences, in particular, higher schizotypy reported in North-America. The various associations of some APS/BIPS contents with country, age, comorbidities, and functioning might moderate their clinical severity and, consequently, the related risk for psychosis and/or persistent functional disability.
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Affiliation(s)
- Christian Theisen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck-Institute of Psychiatry, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Research Center Jülich, Institute for Cognitive Neuroscience (INM-3), Jülich, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Department of Psychology, Aston University, Birmingham, United Kingdom
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Linda A. Antonucci
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen J. Wood
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Orygen, The National Centre of Excellence for Youth Mental Health, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck-Institute of Psychiatry, Munich, Germany
| | - Jarmo Hietala
- Department of Psychiatry, Medical Faculty, University of Turku, Turku, Finland
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - André Schmidt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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18
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Dwyer DB, Chand GB, Pigoni A, Khuntia A, Wen J, Antoniades M, Hwang G, Erus G, Doshi J, Srinivasan D, Varol E, Kahn RS, Schnack HG, Meisenzahl E, Wood SJ, Zhuo C, Sotiras A, Shinohara RT, Shou H, Fan Y, Schaulfelberger M, Rosa P, Lalousis PA, Upthegrove R, Kaczkurkin AN, Moore TM, Nelson B, Gur RE, Gur RC, Ritchie MD, Satterthwaite TD, Murray RM, Di Forti M, Ciufolini S, Zanetti MV, Wolf DH, Pantelis C, Crespo-Facorro B, Busatto GF, Davatzikos C, Koutsouleris N, Dazzan P. Psychosis brain subtypes validated in first-episode cohorts and related to illness remission: results from the PHENOM consortium. Mol Psychiatry 2023; 28:2008-2017. [PMID: 37147389 PMCID: PMC10575777 DOI: 10.1038/s41380-023-02069-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/15/2023] [Accepted: 04/05/2023] [Indexed: 05/07/2023]
Abstract
Using machine learning, we recently decomposed the neuroanatomical heterogeneity of established schizophrenia to discover two volumetric subgroups-a 'lower brain volume' subgroup (SG1) and an 'higher striatal volume' subgroup (SG2) with otherwise normal brain structure. In this study, we investigated whether the MRI signatures of these subgroups were also already present at the time of the first-episode of psychosis (FEP) and whether they were related to clinical presentation and clinical remission over 1-, 3-, and 5-years. We included 572 FEP and 424 healthy controls (HC) from 4 sites (Sao Paulo, Santander, London, Melbourne) of the PHENOM consortium. Our prior MRI subgrouping models (671 participants; USA, Germany, and China) were applied to both FEP and HC. Participants were assigned into 1 of 4 categories: subgroup 1 (SG1), subgroup 2 (SG2), no subgroup membership ('None'), and mixed SG1 + SG2 subgroups ('Mixed'). Voxel-wise analyses characterized SG1 and SG2 subgroups. Supervised machine learning analyses characterized baseline and remission signatures related to SG1 and SG2 membership. The two dominant patterns of 'lower brain volume' in SG1 and 'higher striatal volume' (with otherwise normal neuromorphology) in SG2 were identified already at the first episode of psychosis. SG1 had a significantly higher proportion of FEP (32%) vs. HC (19%) than SG2 (FEP, 21%; HC, 23%). Clinical multivariate signatures separated the SG1 and SG2 subgroups (balanced accuracy = 64%; p < 0.0001), with SG2 showing higher education but also greater positive psychosis symptoms at first presentation, and an association with symptom remission at 1-year, 5-year, and when timepoints were combined. Neuromorphological subtypes of schizophrenia are already evident at illness onset, separated by distinct clinical presentations, and differentially associated with subsequent remission. These results suggest that the subgroups may be underlying risk phenotypes that could be targeted in future treatment trials and are critical to consider when interpreting neuroimaging literature.
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Affiliation(s)
- Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany.
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
- Orygen, Melbourne, VIC, Australia.
| | - Ganesh B Chand
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Adyasha Khuntia
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
- Max-Planck Institute of Psychiatry, Munich, Germany
| | - Junhao Wen
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mathilde Antoniades
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gyujoon Hwang
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Guray Erus
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jimit Doshi
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dhivya Srinivasan
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erdem Varol
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Statistics, Zuckerman Institute, Columbia University, New York, NY, USA
| | - Rene S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hugo G Schnack
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Eva Meisenzahl
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Stephen J Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- Orygen, Melbourne, VIC, Australia
- University of Birmingham, Edgbaston, UK
| | - Chuanjun Zhuo
- Department of Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Tianjin Anding Hospital; Department of Psychiatry, Tianjin Medical University, Tianjin, China
| | - Aristeidis Sotiras
- Department of Radiology and Institute for Informatics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Russell T Shinohara
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Haochang Shou
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yong Fan
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Pedro Rosa
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paris A Lalousis
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, UK
- Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Tyler M Moore
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barnaby Nelson
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- Orygen, Melbourne, VIC, Australia
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marylyn D Ritchie
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore D Satterthwaite
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Robin M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Marta Di Forti
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Simone Ciufolini
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Marcus V Zanetti
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Daniel H Wolf
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
| | - Benedicto Crespo-Facorro
- Mental Health Service, Hospital Universitario Virgen del Rocío, Seville, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
| | - Geraldo F Busatto
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany.
- Max-Planck Institute of Psychiatry, Munich, Germany.
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
| | - Paola Dazzan
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
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19
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Hwang G, Wen J, Sotardi S, Brodkin ES, Chand GB, Dwyer DB, Erus G, Doshi J, Singhal P, Srinivasan D, Varol E, Sotiras A, Dazzan P, Kahn RS, Schnack HG, Zanetti MV, Meisenzahl E, Busatto GF, Crespo-Facorro B, Pantelis C, Wood SJ, Zhuo C, Shinohara RT, Shou H, Fan Y, Di Martino A, Koutsouleris N, Gur RE, Gur RC, Satterthwaite TD, Wolf DH, Davatzikos C. Assessment of Neuroanatomical Endophenotypes of Autism Spectrum Disorder and Association With Characteristics of Individuals With Schizophrenia and the General Population. JAMA Psychiatry 2023; 80:498-507. [PMID: 37017948 PMCID: PMC10157419 DOI: 10.1001/jamapsychiatry.2023.0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Importance Autism spectrum disorder (ASD) is associated with significant clinical, neuroanatomical, and genetic heterogeneity that limits precision diagnostics and treatment. Objective To assess distinct neuroanatomical dimensions of ASD using novel semisupervised machine learning methods and to test whether the dimensions can serve as endophenotypes also in non-ASD populations. Design, Setting, and Participants This cross-sectional study used imaging data from the publicly available Autism Brain Imaging Data Exchange (ABIDE) repositories as the discovery cohort. The ABIDE sample included individuals diagnosed with ASD aged between 16 and 64 years and age- and sex-match typically developing individuals. Validation cohorts included individuals with schizophrenia from the Psychosis Heterogeneity Evaluated via Dimensional Neuroimaging (PHENOM) consortium and individuals from the UK Biobank to represent the general population. The multisite discovery cohort included 16 internationally distributed imaging sites. Analyses were performed between March 2021 and March 2022. Main Outcomes and Measures The trained semisupervised heterogeneity through discriminative analysis models were tested for reproducibility using extensive cross-validations. It was then applied to individuals from the PHENOM and the UK Biobank. It was hypothesized that neuroanatomical dimensions of ASD would display distinct clinical and genetic profiles and would be prominent also in non-ASD populations. Results Heterogeneity through discriminative analysis models trained on T1-weighted brain magnetic resonance images of 307 individuals with ASD (mean [SD] age, 25.4 [9.8] years; 273 [88.9%] male) and 362 typically developing control individuals (mean [SD] age, 25.8 [8.9] years; 309 [85.4%] male) revealed that a 3-dimensional scheme was optimal to capture the ASD neuroanatomy. The first dimension (A1: aginglike) was associated with smaller brain volume, lower cognitive function, and aging-related genetic variants (FOXO3; Z = 4.65; P = 1.62 × 10-6). The second dimension (A2: schizophrenialike) was characterized by enlarged subcortical volumes, antipsychotic medication use (Cohen d = 0.65; false discovery rate-adjusted P = .048), partially overlapping genetic, neuroanatomical characteristics to schizophrenia (n = 307), and significant genetic heritability estimates in the general population (n = 14 786; mean [SD] h2, 0.71 [0.04]; P < 1 × 10-4). The third dimension (A3: typical ASD) was distinguished by enlarged cortical volumes, high nonverbal cognitive performance, and biological pathways implicating brain development and abnormal apoptosis (mean [SD] β, 0.83 [0.02]; P = 4.22 × 10-6). Conclusions and Relevance This cross-sectional study discovered 3-dimensional endophenotypic representation that may elucidate the heterogeneous neurobiological underpinnings of ASD to support precision diagnostics. The significant correspondence between A2 and schizophrenia indicates a possibility of identifying common biological mechanisms across the 2 mental health diagnoses.
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Affiliation(s)
- Gyujoon Hwang
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Junhao Wen
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Laboratory of AI & Biomedical Science (LABS), Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Marina del Rey
| | - Susan Sotardi
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Edward S Brodkin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ganesh B Chand
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Radiology, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Guray Erus
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jimit Doshi
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Pankhuri Singhal
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Dhivya Srinivasan
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Erdem Varol
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Statistics, Zuckerman Institute, Columbia University, New York, New York
| | - Aristeidis Sotiras
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Radiology, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rene S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hugo G Schnack
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcus V Zanetti
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Eva Meisenzahl
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Geraldo F Busatto
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Benedicto Crespo-Facorro
- University Hospital Virgen del Rocio, Department of Psychiatry, School of Medicine, IBiS-CIBERSAM, University of Sevilla, Seville, Spain
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Stephen J Wood
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
| | - Chuanjun Zhuo
- Department of Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory, Tianjin Anding Hospital, Tianjin, China
- Department of Psychiatry, Tianjin Medical University, Tianjin, China
| | - Russell T Shinohara
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Haochang Shou
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yong Fan
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Adriana Di Martino
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience at the New York University Child Study Center, New York
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Theodore D Satterthwaite
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel H Wolf
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Christos Davatzikos
- AI 2 D Center for Data Science for Integrated Diagnostics, and Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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20
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Haidl TK, Hedderich DM, Rosen M, Kaiser N, Seves M, Lichtenstein T, Penzel N, Wenzel J, Kambeitz-Ilankovic L, Ruef A, Popovic D, Schultze-Lutter F, Chisholm K, Upthegrove R, Salokangas RKR, Pantelis C, Meisenzahl E, Wood SJ, Brambilla P, Borgwardt S, Ruhrmann S, Kambeitz J, Koutsouleris N. The non-specific nature of mental health and structural brain outcomes following childhood trauma. Psychol Med 2023; 53:1005-1014. [PMID: 34225834 DOI: 10.1017/s0033291721002439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Childhood trauma (CT) is associated with an increased risk of mental health disorders; however, it is unknown whether this represents a diagnosis-specific risk factor for specific psychopathology mediated by structural brain changes. Our aim was to explore whether (i) a predictive CT pattern for transdiagnostic psychopathology exists, and whether (ii) CT can differentiate between distinct diagnosis-dependent psychopathology. Furthermore, we aimed to identify the association between CT, psychopathology and brain structure. METHODS We used multivariate pattern analysis in data from 643 participants of the Personalised Prognostic Tools for Early Psychosis Management study (PRONIA), including healthy controls (HC), recent onset psychosis (ROP), recent onset depression (ROD), and patients clinically at high-risk for psychosis (CHR). Participants completed structured interviews and self-report measures including the Childhood Trauma Questionnaire, SCID diagnostic interview, BDI-II, PANSS, Schizophrenia Proneness Instrument, Structured Interview for Prodromal Symptoms and structural MRI, analyzed by voxel-based morphometry. RESULTS (i) Patients and HC could be distinguished by their CT pattern with a reasonable precision [balanced accuracy of 71.2% (sensitivity = 72.1%, specificity = 70.4%, p ≤ 0.001]. (ii) Subdomains 'emotional neglect' and 'emotional abuse' were most predictive for CHR and ROP, while in ROD 'physical abuse' and 'sexual abuse' were most important. The CT pattern was significantly associated with the severity of depressive symptoms in ROD, ROP, and CHR, as well as with the PANSS total and negative domain scores in the CHR patients. No associations between group-separating CT patterns and brain structure were found. CONCLUSIONS These results indicate that CT poses a transdiagnostic risk factor for mental health disorders, possibly related to depressive symptoms. While differences in the quality of CT exposure exist, diagnostic differentiation was not possible suggesting a multi-factorial pathogenesis.
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Affiliation(s)
- Theresa K Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Dennis M Hedderich
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine Technical University of Munich, Munich, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Nathalie Kaiser
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Mauro Seves
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Lichtenstein
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katharine Chisholm
- Institute of Mental Health, University of Birmingham, Birmingham, UK
- Department of Psychology, Aston University, Birmingham, UK
| | - Rachel Upthegrove
- Institute of Mental Health, University of Birmingham, Birmingham, UK
- Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust, UK
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Victoria, Australia
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephen J Wood
- Institute of Mental Health, University of Birmingham, Birmingham, UK
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Max-Planck Institute of Psychiatry Munich, Munich, Germany
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21
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Osman N, Chow WS, Michel C, Meisenzahl E, Schimmelmann BG, Schultze-Lutter F. Psychometric properties of the Kessler psychological scales in a Swiss young-adult community sample indicate poor suitability for community screening for mental disorders. Early Interv Psychiatry 2023; 17:85-95. [PMID: 35352501 DOI: 10.1111/eip.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/18/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM The Kessler psychological distress scales (K10 and K6) are used as screening tools to assess psychological distress related to the likely presence of a mental disorder. Thus, we studied the psychometric properties of their German versions in a Swiss community sample to evaluate their potential usefulness to screen for mental disorders or relevant mental problems in the community and, relatedly, for low threshold transdiagnostic German-speaking services. METHODS The sample consisted of 829 citizens of the Swiss canton Bern of age 19-43 years. K10/K6 were validated against mini-international neuropsychiatric interview (M.I.N.I.) diagnoses, questionnaires about health status and quality of life. Receiver operating characteristic (ROC) curve analyses were used to test for general discriminative ability and to select optimal cut-offs of the K10 and K6 for non-psychotic full-blown and subthreshold mental disorders. RESULTS Cronbach's alphas were 0.81 (K10) and 0.70 (K6). ROC analyses indicated much lower optimal thresholds than earlier suggested; 10 for K10 and 6 for K6. At these thresholds, against M.I.N.I. diagnoses, Cohen's κ (≤0.173) and correspondence rates (≤58.14%) were insufficient throughout. Values were higher at the earlier suggested threshold, yet, at the cost of sensitivity that was below 0.5 in all but three, and below 0.3 in all but six cases. CONCLUSIONS For the lack of sufficient validity and sensitivity, respectively, our findings suggest that both K10 and K6 would only be of limited use in a low-threshold transdiagnostic mental health service for young adults in Switzerland and likely other German-speaking countries.
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Affiliation(s)
- Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Winnie S Chow
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
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22
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Lencer R, Schwarzer J, Meyhoefer I, Antonucci LA, Kambeitz-Ilankovic L, Surmann M, Bienek O, Romer G, Dannlowski U, Hahn T, Korda A, Dwyer DB, Ruef A, Haas SS, Kambeitz J, Salokangas RK, Pantelis C, Schultze-Lutter F, Meisenzahl E, Brambilla P, Bertolino A, Borgwardt S, Upthegrove R, Koutsouleris N. Visual disturbances in recent-onset psychosis and clinical high-risk state for psychosis. J Vis 2022. [DOI: 10.1167/jov.22.14.3529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nikolaos Koutsouleris
- Ludwig Maximilian University Munich
- Max-Planck-Institute of Psychiatry Munich
- King's College London
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23
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Lalousis PA, Schmaal L, Wood SJ, Reniers RLEP, Barnes NM, Chisholm K, Griffiths SL, Stainton A, Wen J, Hwang G, Davatzikos C, Wenzel J, Kambeitz-Ilankovic L, Andreou C, Bonivento C, Dannlowski U, Ferro A, Lichtenstein T, Riecher-Rössler A, Romer G, Rosen M, Bertolino A, Borgwardt S, Brambilla P, Kambeitz J, Lencer R, Pantelis C, Ruhrmann S, Salokangas RKR, Schultze-Lutter F, Schmidt A, Meisenzahl E, Koutsouleris N, Dwyer D, Upthegrove R. Neurobiologically Based Stratification of Recent-Onset Depression and Psychosis: Identification of Two Distinct Transdiagnostic Phenotypes. Biol Psychiatry 2022; 92:552-562. [PMID: 35717212 PMCID: PMC10128104 DOI: 10.1016/j.biopsych.2022.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Identifying neurobiologically based transdiagnostic categories of depression and psychosis may elucidate heterogeneity and provide better candidates for predictive modeling. We aimed to identify clusters across patients with recent-onset depression (ROD) and recent-onset psychosis (ROP) based on structural neuroimaging data. We hypothesized that these transdiagnostic clusters would identify patients with poor outcome and allow more accurate prediction of symptomatic remission than traditional diagnostic structures. METHODS HYDRA (Heterogeneity through Discriminant Analysis) was trained on whole-brain volumetric measures from 577 participants from the discovery sample of the multisite PRONIA study to identify neurobiologically driven clusters, which were then externally validated in the PRONIA replication sample (n = 404) and three datasets of chronic samples (Centre for Biomedical Research Excellence, n = 146; Mind Clinical Imaging Consortium, n = 202; Munich, n = 470). RESULTS The optimal clustering solution was two transdiagnostic clusters (cluster 1: n = 153, 67 ROP, 86 ROD; cluster 2: n = 149, 88 ROP, 61 ROD; adjusted Rand index = 0.618). The two clusters contained both patients with ROP and patients with ROD. One cluster had widespread gray matter volume deficits and more positive, negative, and functional deficits (impaired cluster), and one cluster revealed a more preserved neuroanatomical signature and more core depressive symptomatology (preserved cluster). The clustering solution was internally and externally validated and assessed for clinical utility in predicting 9-month symptomatic remission, outperforming traditional diagnostic structures. CONCLUSIONS We identified two transdiagnostic neuroanatomically informed clusters that are clinically and biologically distinct, challenging current diagnostic boundaries in recent-onset mental health disorders. These results may aid understanding of the etiology of poor outcome patients transdiagnostically and improve development of stratified treatments.
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Affiliation(s)
- Paris Alexandros Lalousis
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom.
| | - Lianne Schmaal
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Renate L E P Reniers
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nicholas M Barnes
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Department of Psychology, Aston University, Birmingham, United Kingdom
| | - Sian Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Alexandra Stainton
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Junhao Wen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gyujoon Hwang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christos Davatzikos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - Carolina Bonivento
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Adele Ferro
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - Georg Romer
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Paolo Brambilla
- Department of Psychiatry, University of Basel, Basel, Switzerland; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Ludwig Maxmilians University, Munich, Germany
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephan Ruhrmann
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | | | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - André Schmidt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maxmilians University, Munich, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig Maxmilians University, Munich, Germany
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Birmingham Early Interventions Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
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24
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Squarcina L, Kambeitz-Ilankovic L, Bonivento C, Prunas C, Oldani L, Wenzel J, Ruef A, Dwyer D, Ferro A, Borgwardt S, Kambeitz J, Lichtenstein TK, Meisenzahl E, Pantelis C, Rosen M, Upthegrove R, Antonucci LA, Bertolino A, Lencer R, Ruhrmann S, Salokangas RRK, Schultze-Lutter F, Chisholm K, Stainton A, Wood SJ, Koutsouleris N, Brambilla P. Relationships between global functioning and neuropsychological predictors in subjects at high risk of psychosis or with a recent onset of depression. World J Biol Psychiatry 2022; 23:573-581. [PMID: 35048791 DOI: 10.1080/15622975.2021.2014955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Psychotic disorders are frequently associated with decline in functioning and cognitive difficulties are observed in subjects at clinical high risk (CHR) for psychosis. In this work, we applied automatic approaches to neurocognitive and functioning measures, with the aim of investigating the link between global, social and occupational functioning, and cognition. METHODS 102 CHR subjects and 110 patients with recent onset depression (ROD) were recruited. Global assessment of functioning (GAF) related to symptoms (GAF-S) and disability (GAF-D). and global functioning social (GF-S) and role (GF-R), at baseline and of the previous month and year, and a set of neurocognitive measures, were used for classification and regression. RESULTS Neurocognitive measures related to GF-R at baseline (r = 0.20, p = 0.004), GF-S at present (r = 0.14, p = 0.042) and of the past year (r = 0.19, p = 0.005), for GAF-F of the past month (r = 0.24, p < 0.001) and GAF-D of the past year (r = 0.28, p = 0.002). Classification reached values of balanced accuracy of 61% for GF-R and GAF-D. CONCLUSION We found that neurocognition was related to psychosocial functioning. More specifically, a deficit in executive functions was associated to poor social and occupational functioning.
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Affiliation(s)
- Letizia Squarcina
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - Cecilia Prunas
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucio Oldani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Adele Ferro
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefan Borgwardt
- Department of Psychiatry, (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lubeck, Lubeck, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Theresa Katharina Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Dusseldorf, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Linda A Antonucci
- Department of Education, Psychology and Communication, University of Bari "Aldo Moro" - Bari, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lubeck, Lubeck, Germany.,Institute for Translational Psychiatry, Westfalische-Wilhelms-University Munster, Munster, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Dusseldorf, Germany.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Katharine Chisholm
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Alexandra Stainton
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,Orygen, Melbourne, Australia.,Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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25
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Osman N, Michel C, Schimmelmann BG, Schilbach L, Meisenzahl E, Schultze-Lutter F. Influence of mental health literacy on help-seeking behaviour for mental health problems in the Swiss young adult community: a cohort and longitudinal case-control study. Eur Arch Psychiatry Clin Neurosci 2022; 273:649-662. [PMID: 36088495 PMCID: PMC10085901 DOI: 10.1007/s00406-022-01483-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
Poor knowledge about mental health disorders and their treatment likely contributes to the large treatment gap reported for mental health problems. Therefore, we studied the association between mental health literacy (MHL) and active help-seeking in a community sample. Participants were recruited from an add-on questionnaire study to the 'Bern Epidemiological At-Risk' (BEAR) study on 16-40-year-old community subjects of the Swiss canton Bern. At baseline, data of N = 1504, and at 3-year follow-up, data of N = 535 were available. Based on an unlabelled case vignette (on depression or schizophrenia), MHL was assessed by the questionnaire of Angermeyer and colleagues. Cross-sectional and longitudinal baseline predictors of help-seeking were analysed using path analyses. Additionally, sensitivity analyses of the prospective model were computed for sex, vignette, and baseline mental health problems/disorders. Cross-sectionally, help-seeking was associated with non-endorsement of biogenetic causal explanations, presence of mental health problems/disorders, help-seeking before baseline, poorer functioning, and lower health satisfaction. The prospective model was similar; yet, help-seeking at follow-up was associated with endorsements of the causal explanation 'biogenetics' and, additionally, 'childhood trauma' but not the presence of baseline mental health problems/disorders. Sensitivity analyses revealed a significant impact on sex, vignette, and mental health problems/disorders. For example, actual functional problems were predictive in males, while health satisfaction was predictive in females. Our findings indicate that future studies on drivers of help-seeking should assess very large community samples with case vignettes on different mental disorders to examine appropriate subgroups and their likely interaction to address group-specific factors in awareness campaigns.
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Affiliation(s)
- N Osman
- Department of Psychiatry and Psychotherapy/LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany.
| | - C Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - B G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - L Schilbach
- Department of Psychiatry and Psychotherapy/LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany.,Medical Faculty, Ludwig Maximilians Universität, Munich, Germany
| | - E Meisenzahl
- Department of Psychiatry and Psychotherapy/LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany
| | - F Schultze-Lutter
- Department of Psychiatry and Psychotherapy/LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
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26
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Chand GB, Singhal P, Dwyer DB, Wen J, Erus G, Doshi J, Srinivasan D, Mamourian E, Varol E, Sotiras A, Hwang G, Dazzan P, Kahn RS, Schnack HG, Zanetti MV, Meisenzahl E, Busatto GF, Crespo-Facorro B, Pantelis C, Wood SJ, Zhuo C, Shinohara RT, Shou H, Fan Y, Koutsouleris N, Kaczkurkin AN, Moore TM, Verma A, Calkins ME, Gur RE, Gur RC, Ritchie MD, Satterthwaite TD, Wolf DH, Davatzikos C. Schizophrenia Imaging Signatures and Their Associations With Cognition, Psychopathology, and Genetics in the General Population. Am J Psychiatry 2022; 179:650-660. [PMID: 35410495 PMCID: PMC9444886 DOI: 10.1176/appi.ajp.21070686] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The prevalence and significance of schizophrenia-related phenotypes at the population level is debated in the literature. Here, the authors assessed whether two recently reported neuroanatomical signatures of schizophrenia-signature 1, with widespread reduction of gray matter volume, and signature 2, with increased striatal volume-could be replicated in an independent schizophrenia sample, and investigated whether expression of these signatures can be detected at the population level and how they relate to cognition, psychosis spectrum symptoms, and schizophrenia genetic risk. METHODS This cross-sectional study used an independent schizophrenia-control sample (N=347; ages 16-57 years) for replication of imaging signatures, and then examined two independent population-level data sets: typically developing youths and youths with psychosis spectrum symptoms in the Philadelphia Neurodevelopmental Cohort (N=359; ages 16-23 years) and adults in the UK Biobank study (N=836; ages 44-50 years). The authors quantified signature expression using support-vector machine learning and compared cognition, psychopathology, and polygenic risk between signatures. RESULTS Two neuroanatomical signatures of schizophrenia were replicated. Signature 1 but not signature 2 was significantly more common in youths with psychosis spectrum symptoms than in typically developing youths, whereas signature 2 frequency was similar in the two groups. In both youths and adults, signature 1 was associated with worse cognitive performance than signature 2. Compared with adults with neither signature, adults expressing signature 1 had elevated schizophrenia polygenic risk scores, but this was not seen for signature 2. CONCLUSIONS The authors successfully replicated two neuroanatomical signatures of schizophrenia and describe their prevalence in population-based samples of youths and adults. They further demonstrated distinct relationships of these signatures with psychosis symptoms, cognition, and genetic risk, potentially reflecting underlying neurobiological vulnerability.
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Affiliation(s)
- Ganesh B Chand
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Pankhuri Singhal
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Dominic B Dwyer
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Junhao Wen
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Guray Erus
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Jimit Doshi
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Dhivya Srinivasan
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Elizabeth Mamourian
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Erdem Varol
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Aristeidis Sotiras
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Gyujoon Hwang
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Paola Dazzan
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Rene S Kahn
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Hugo G Schnack
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Marcus V Zanetti
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Eva Meisenzahl
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Geraldo F Busatto
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Benedicto Crespo-Facorro
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Christos Pantelis
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Stephen J Wood
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Chuanjun Zhuo
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Russell T Shinohara
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Haochang Shou
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Yong Fan
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Nikolaos Koutsouleris
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Antonia N Kaczkurkin
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Tyler M Moore
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Anurag Verma
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Monica E Calkins
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Raquel E Gur
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Ruben C Gur
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Marylyn D Ritchie
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Theodore D Satterthwaite
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Daniel H Wolf
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, Satterthwaite, Wolf, Davatzikos, Shinohara, Shou), Department of Radiology (Chand, Wen, Erus, Doshi, Srinivasan, Mamourian, Varol, Sotiras, Hwang, Fan, R.E. Gur, R.C. Gur, Davatzikos), Department of Genetics (Singhal, Verma, Ritchie), Department of Psychiatry (Kaczkurkin, Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite, Wolf), and Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics (Shinohara, Shou), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Radiology, School of Medicine (Chand, Sotiras), and Institute of Informatics (Sotiras), Washington University in St. Louis; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich (Dwyer, Koutsouleris); Department of Statistics, Zuckerman Institute, Columbia University, New York (Varol); Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dazzan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Kahn); Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Schnack); Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Zanetti, Busatto); Hospital Sírio-Libanês, São Paulo, Brazil (Zanetti); LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany (Meisenzahl); Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio, IBiS-CIBERSAM, University of Sevilla, Spain (Crespo-Facorro); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia (Pantelis); Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia (Wood); School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); Department of Psychiatric Neuroimaging Genetics and Comorbidity Laboratory, Nankai University Affiliated Tianjin Anding Hospital, and Department of Psychiatry, Tianjin Medical University, Tianjin, China (Zhuo); Department of Psychology, Vanderbilt University, Nashville (Kaczkurkin); Lifespan Brain Institute of Penn Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia (Moore, Calkins, R.E. Gur, R.C. Gur, Satterthwaite)
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27
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Koutsouleris N, Pantelis C, Velakoulis D, McGuire P, Dwyer DB, Urquijo-Castro MF, Paul R, Dong S, Popovic D, Oeztuerk O, Kambeitz J, Salokangas RKR, Hietala J, Bertolino A, Brambilla P, Upthegrove R, Wood SJ, Lencer R, Borgwardt S, Maj C, Nöthen M, Degenhardt F, Polyakova M, Mueller K, Villringer A, Danek A, Fassbender K, Fliessbach K, Jahn H, Kornhuber J, Landwehrmeyer B, Anderl-Straub S, Prudlo J, Synofzik M, Wiltfang J, Riedl L, Diehl-Schmid J, Otto M, Meisenzahl E, Falkai P, Schroeter ML. Exploring Links Between Psychosis and Frontotemporal Dementia Using Multimodal Machine Learning: Dementia Praecox Revisited. JAMA Psychiatry 2022; 79:907-919. [PMID: 35921104 PMCID: PMC9350851 DOI: 10.1001/jamapsychiatry.2022.2075] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/12/2022] [Indexed: 12/04/2022]
Abstract
Importance The behavioral and cognitive symptoms of severe psychotic disorders overlap with those seen in dementia. However, shared brain alterations remain disputed, and their relevance for patients in at-risk disease stages has not been explored so far. Objective To use machine learning to compare the expression of structural magnetic resonance imaging (MRI) patterns of behavioral-variant frontotemporal dementia (bvFTD), Alzheimer disease (AD), and schizophrenia; estimate predictability in patients with bvFTD and schizophrenia based on sociodemographic, clinical, and biological data; and examine prognostic value, genetic underpinnings, and progression in patients with clinical high-risk (CHR) states for psychosis or recent-onset depression (ROD). Design, Setting, and Participants This study included 1870 individuals from 5 cohorts, including (1) patients with bvFTD (n = 108), established AD (n = 44), mild cognitive impairment or early-stage AD (n = 96), schizophrenia (n = 157), or major depression (n = 102) to derive and compare diagnostic patterns and (2) patients with CHR (n = 160) or ROD (n = 161) to test patterns' prognostic relevance and progression. Healthy individuals (n = 1042) were used for age-related and cohort-related data calibration. Data were collected from January 1996 to July 2019 and analyzed between April 2020 and April 2022. Main Outcomes and Measures Case assignments based on diagnostic patterns; sociodemographic, clinical, and biological data; 2-year functional outcomes and genetic separability of patients with CHR and ROD with high vs low pattern expression; and pattern progression from baseline to follow-up MRI scans in patients with nonrecovery vs preserved recovery. Results Of 1870 included patients, 902 (48.2%) were female, and the mean (SD) age was 38.0 (19.3) years. The bvFTD pattern comprising prefrontal, insular, and limbic volume reductions was more expressed in patients with schizophrenia (65 of 157 [41.2%]) and major depression (22 of 102 [21.6%]) than the temporo-limbic AD patterns (28 of 157 [17.8%] and 3 of 102 [2.9%], respectively). bvFTD expression was predicted by high body mass index, psychomotor slowing, affective disinhibition, and paranoid ideation (R2 = 0.11). The schizophrenia pattern was expressed in 92 of 108 patients (85.5%) with bvFTD and was linked to the C9orf72 variant, oligoclonal banding in the cerebrospinal fluid, cognitive impairment, and younger age (R2 = 0.29). bvFTD and schizophrenia pattern expressions forecasted 2-year psychosocial impairments in patients with CHR and were predicted by polygenic risk scores for frontotemporal dementia, AD, and schizophrenia. Findings were not associated with AD or accelerated brain aging. Finally, 1-year bvFTD/schizophrenia pattern progression distinguished patients with nonrecovery from those with preserved recovery. Conclusions and Relevance Neurobiological links may exist between bvFTD and psychosis focusing on prefrontal and salience system alterations. Further transdiagnostic investigations are needed to identify shared pathophysiological processes underlying the neuroanatomical interface between the 2 disease spectra.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Max-Planck Institute of Psychiatry, Munich, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
| | - Dennis Velakoulis
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
| | - Philip McGuire
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Dominic B. Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | | | - Riya Paul
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Sen Dong
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Oemer Oeztuerk
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | | | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Rachel Upthegrove
- Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom
- Early Intervention Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Stephen J. Wood
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, Melbourne, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Institute for Translational Psychiatry, University Muenster, Muenster, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Department of Psychiatry, University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Carlo Maj
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Markus Nöthen
- Institute of Human Genetics, School of Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, School of Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Maryna Polyakova
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Karsten Mueller
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig Maximilian University Munich, Munich, Germany
| | - Klaus Fassbender
- Department of Neurology, Saarland University Hospital, Homburg, Germany
| | - Klaus Fliessbach
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Holger Jahn
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg, Hamburg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Johannes Prudlo
- Department of Neurology, University Medicine Rostock, Rostock, Germany
| | - Matthis Synofzik
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Neurodegenerative Diseases, Center of Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Jens Wiltfang
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Psychiatry and Psychotherapy, Medical University Göttingen, Göttingen, Germany
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Matthias L. Schroeter
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
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28
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Dwyer DB, Buciuman MO, Ruef A, Kambeitz J, Sen Dong M, Stinson C, Kambeitz-Ilankovic L, Degenhardt F, Sanfelici R, Antonucci LA, Lalousis PA, Wenzel J, Urquijo-Castro MF, Popovic D, Oeztuerk OF, Haas SS, Weiske J, Hauke D, Neufang S, Schmidt-Kraepelin C, Ruhrmann S, Penzel N, Lichtenstein T, Rosen M, Chisholm K, Riecher-Rössler A, Egloff L, Schmidt A, Andreou C, Hietala J, Schirmer T, Romer G, Michel C, Rössler W, Maj C, Borisov O, Krawitz PM, Falkai P, Pantelis C, Lencer R, Bertolino A, Borgwardt S, Noethen M, Brambilla P, Schultze-Lutter F, Meisenzahl E, Wood SJ, Davatzikos C, Upthegrove R, Salokangas RKR, Koutsouleris N. Clinical, Brain, and Multilevel Clustering in Early Psychosis and Affective Stages. JAMA Psychiatry 2022; 79:677-689. [PMID: 35583903 PMCID: PMC9118078 DOI: 10.1001/jamapsychiatry.2022.1163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Approaches are needed to stratify individuals in early psychosis stages beyond positive symptom severity to investigate specificity related to affective and normative variation and to validate solutions with premorbid, longitudinal, and genetic risk measures. Objective To use machine learning techniques to cluster, compare, and combine subgroup solutions using clinical and brain structural imaging data from early psychosis and depression stages. Design, Setting, and Participants A multisite, naturalistic, longitudinal cohort study (10 sites in 5 European countries; including major follow-up intervals at 9 and 18 months) with a referred patient sample of those with clinical high risk for psychosis (CHR-P), recent-onset psychosis (ROP), recent-onset depression (ROD), and healthy controls were recruited between February 1, 2014, to July 1, 2019. Data were analyzed between January 2020 and January 2022. Main Outcomes and Measures A nonnegative matrix factorization technique separately decomposed clinical (287 variables) and parcellated brain structural volume (204 gray, white, and cerebrospinal fluid regions) data across CHR-P, ROP, ROD, and healthy controls study groups. Stability criteria determined cluster number using nested cross-validation. Validation targets were compared across subgroup solutions (premorbid, longitudinal, and schizophrenia polygenic risk scores). Multiclass supervised machine learning produced a transferable solution to the validation sample. Results There were a total of 749 individuals in the discovery group and 610 individuals in the validation group. Individuals included those with CHR-P (n = 287), ROP (n = 323), ROD (n = 285), and healthy controls (n = 464), The mean (SD) age was 25.1 (5.9) years, and 702 (51.7%) were female. A clinical 4-dimensional solution separated individuals based on positive symptoms, negative symptoms, depression, and functioning, demonstrating associations with all validation targets. Brain clustering revealed a subgroup with distributed brain volume reductions associated with negative symptoms, reduced performance IQ, and increased schizophrenia polygenic risk scores. Multilevel results distinguished between normative and illness-related brain differences. Subgroup results were largely validated in the external sample. Conclusions and Relevance The results of this longitudinal cohort study provide stratifications beyond the expression of positive symptoms that cut across illness stages and diagnoses. Clinical results suggest the importance of negative symptoms, depression, and functioning. Brain results suggest substantial overlap across illness stages and normative variation, which may highlight a vulnerability signature independent from specific presentations. Premorbid, longitudinal, and genetic risk validation suggested clinical importance of the subgroups to preventive treatments.
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Affiliation(s)
- Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Madalina-Octavia Buciuman
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Mark Sen Dong
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Caedyn Stinson
- Max-Planck School of Cognition, Leipzig, Germany.,Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Linda A Antonucci
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy
| | - Paris Alexandros Lalousis
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Oemer Faruk Oeztuerk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johanna Weiske
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Daniel Hauke
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland.,Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom.,Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Katharine Chisholm
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, United Kingdom.,Department of Psychology, Aston University, Birmingham, United Kingdom
| | | | - Laura Egloff
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - André Schmidt
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Christina Andreou
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Timo Schirmer
- GE Healthcare GmbH (previously GE Global Research GmbH), Munich, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University of Münster, Münster, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Carlo Maj
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Oleg Borisov
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Peter M Krawitz
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Markus Noethen
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | | | - Stephen J Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Christos Davatzikos
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, United Kingdom.,Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Schultze-Lutter F, Michel C, Schimmelmann B, Meisenzahl E, Osman N. Are the Kessler Psychological Scales suitable for screening for mental disorders in low-threshold mental health services in German-speaking countries? Eur Psychiatry 2022. [PMCID: PMC9567448 DOI: 10.1192/j.eurpsy.2022.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
The Kessler Psychological Distress Scales (K10 and K6) are used as screening tools to assess psychological distress and are the first-line assessment of need for help in the Headspace services.
Objectives
Thus, we studied the psychometric properties of their German versions in a Swiss community sample to evaluate their potential usefulness to screen for mental disorders or relevant mental problems in low threshold transdiagnostic German-speaking services.
Methods
The sample consisted of 829 citizens of the Swiss canton Bern of age 19-43 years. K10/K6 were validated against Mini-International Neuropsychiatric Interview (M.I.N.I.) diagnoses, questionnaires about health status and quality of life. Receiver Operating Characteristic (ROC) curve analyses were used to test for general discriminative ability and to select optimal cut-offs of the K10 and K6 for non-psychotic full-blown and subthreshold mental disorders.
Results
Cronbach’s alphas were 0.81 (K10) and 0.70 (K6). ROC analyses indicated much lower optimal thresholds than earlier suggested; 10 for K10 and 6 for K6. At these thresholds, against M.I.N.I. diagnoses, Cohen’s Kappa (<=0.173) and correspondence rates (<=58.14%) were insufficient throughout. Values were higher at the earlier suggested threshold, yet, at the cost of sensitivity that was below 0.5 in all but three, and below 0.3 in all but six cases.
Conclusions
For the lack of sufficient validity and sensitivity, respectively, our findings suggest that both K10 and K6 would only be of limited use in a low-threshold transdiagnostic mental health service – comparable to Headspace – for young adults in Switzerland and likely other German-speaking countries.
Disclosure
No significant relationships.
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Theisen C, Kieckhäfer C, Röpcke F, Meisenzahl E. Investigating causes of increased morbidity and mortality within psychiatric patients - Somatic comorbidities of inpatients in a german psychiatric community hospital. Eur Psychiatry 2022. [PMCID: PMC9567070 DOI: 10.1192/j.eurpsy.2022.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
The co-occurrence of mental illness and somatic comorbidities is a major cause of increased morbidity and mortality within psychiatric patients, compared to the general population. This may be caused by an unhealthy lifestyle, side effects of psychotropic drugs and systematic barriers in healthcare provision. The underlying mechanisms remain under-investigated.
Objectives
We systematically investigated relevant barriers and risk factors to the utilization of primary care among severe mentally ill outpatients.
Methods
In a cross-sectional analysis, the psychiatric as well as somatic diagnoses of inpatients of a German psychiatric community hospital were identified. Furthermore, somatic and psychiatric medication, blood values (HBA1C) and sociodemographic data of the patients were analyzed. The frequencies of the somatic diagnoses were presented according to psychiatric diagnoses. By a Chi-Square goodness-of-Fit Test the distribution of somatic diagnoses and drug classes were verified according to the total cohort as well as for each psychiatric diagnosis and in respect to sex.
Results
Our results provide an overview of common comorbidities with regard to the psychiatric diagnosis. The medication, in relation to the recorded somatic comorbidities, as well as the blood values, allow a conclusion to be drawn about the extent and success of the treatment.
Conclusions
For the first time, real-life data on the somatic diagnoses and treatment of patients with a severe mental illness in a German hospital is presented. Our results will be used to create low-threshold interventions for the most relevant somatic comorbidities and to improve primary care of psychiatric patients through linking the care systems.
Disclosure
No significant relationships.
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31
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Askari I, Wenglorz L, Gajewski FJ, Jänner M, Vetter A, Askari A, Askari S, Balázsy Z, Bramer-Ugur S, Reinermann D, Nolting T, Meisenzahl E, Kujovic M. Predicting the role of coping factors on pandemic-related anxiety. Curr Psychol 2022; 42:1-10. [PMID: 35600263 PMCID: PMC9106324 DOI: 10.1007/s12144-022-03188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/03/2022]
Abstract
The year 2020 saw the emergence of a worldwide pandemic caused by the novel coronavirus COVID-19. Measures against further spread of the virus were taken nearly everywhere in the world. Many countries also imposed social distancing rules and lockdowns on their population. This situation has caused a lot of fear and insecurity, along with reactance and even unrest in some countries. In this study, we measured the psychological concepts of resilience, reactance, positive schemas, social solidarity, and anxiety among psychiatric patients and in how far these factors influence their psychopathological anxiety during the pandemic. The aim was to better understand in what ways these factors influence pandemic anxiety to be able to reduce its negative psychological effects. Findings show a significant effect of positive schemas and social solidarity on the level of pandemic anxiety in a sample of psychiatric patients, but no correlation between resilience or reactance and pandemic anxiety. Based on these insights, the inclusion of positive schemas and social solidarity for therapy should be considered. Looking deeper into the relation between positive schemas and pandemic anxiety could provide insight into the different ways that schemas influence people's anxiety and determine whether some of them are particularly important.
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Affiliation(s)
- Iman Askari
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine Universität, Düsseldorf, Germany
| | | | | | - Michaela Jänner
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine Universität, Düsseldorf, Germany
| | - Alicia Vetter
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine Universität, Düsseldorf, Germany
| | - Amir Askari
- Iranian Institute of Schema Therapy, Tehran, Iran
| | | | - Zsuzsánna Balázsy
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine Universität, Düsseldorf, Germany
| | - Silke Bramer-Ugur
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine Universität, Düsseldorf, Germany
| | - Dirk Reinermann
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine Universität, Düsseldorf, Germany
| | - Thorsten Nolting
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine Universität, Düsseldorf, Germany
| | - Eva Meisenzahl
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine Universität, Düsseldorf, Germany
| | - Milenko Kujovic
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine Universität, Düsseldorf, Germany
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32
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Jimeno N, Gomez-Pilar J, Poza J, Hornero R, Vogeley K, Meisenzahl E, Lichtenstein TK, Rosen M, Kambeitz J, Klosterkötter J, Schultze-Lutter F. (Attenuated) hallucinations join basic symptoms in a transdiagnostic network cluster analysis. Schizophr Res 2022; 243:43-54. [PMID: 35231833 DOI: 10.1016/j.schres.2022.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 01/31/2022] [Accepted: 02/13/2022] [Indexed: 11/16/2022]
Abstract
Hallucinations are considered characteristic symptoms of psychosis and part of the 'psychosis superspectrum' of the Hierarchical Taxonomy Of Psychopathology (HiTOP) initiative. To gain insight into their psychopathological relevance, we studied their dimensional placement within a single dense transdiagnostic network constituting of basic symptoms as well as of attenuated and frank psychotic, and related symptoms. Newman's modularity analysis was used to detect symptom clusters in an earlier generated network (Jimeno, N., et al., 2020. Main symptomatic treatment targets in suspected and early psychosis: New insights from network analysis. Schizophr. Bull. 46, 884-895. https://doi.org/10.1093/schbul/sbz140). The constituting 86 symptoms were assessed with the Schizophrenia Proneness Instrument, Adult version (SPI-A), the Structured Interview for Psychosis-Risk Syndromes (SIPS), and the Positive And Negative Syndrome Scale (PANSS) in three adult samples of an early detection service: clinical high-risk (n = 203), first-episode psychosis (n = 153), and major depression (n = 104). Three clusters were detected: "subjective disturbances", "positive symptoms and behaviors", and "negative and anxious-depressive symptoms". The predominately attenuated hallucinations of both SIPS and PANSS joined the basic symptoms in "subjective disturbances", whereas other positive symptoms entered "positive symptoms and behaviors". Our results underline the importance of insight in separating true psychotic hallucinations from other hallucinatory experiences that, albeit phenomenologically similar are still experienced with some insight, i.e., are present in an attenuated form. We conclude that, strictly, hallucinations held with any degree of insight should not be used to diagnose transition to or presence of frank psychoses and, relatedly, to justify antipsychotic medication.
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Affiliation(s)
- Natalia Jimeno
- Department of Psychiatry, School of Medicine, University of Valladolid, Valladolid, Spain; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; GINCYL, Research Group on Clinical Neuroscience of Castile and Leon, Valladolid, Spain.
| | - Javier Gomez-Pilar
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER-BBN, Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
| | - Jesus Poza
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER-BBN, Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain; IMUVA, Mathematics Research Institute, University of Valladolid, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER-BBN, Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain; IMUVA, Mathematics Research Institute, University of Valladolid, Valladolid, Spain
| | - Kai Vogeley
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; INM3, Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Theresa K Lichtenstein
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joachim Klosterkötter
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Haas SS, Doucet GE, Antoniades M, Modabbernia A, Corcoran CM, Kahn RS, Kambeitz J, Kambeitz-Ilankovic L, Borgwardt S, Brambilla P, Upthegrove R, Wood SJ, Salokangas RK, Hietala J, Meisenzahl E, Koutsouleris N, Frangou S. Evidence of discontinuity between psychosis-risk and non-clinical samples in the neuroanatomical correlates of social function. Schizophr Res Cogn 2022; 29:100252. [PMID: 35391789 PMCID: PMC8980307 DOI: 10.1016/j.scog.2022.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
Objective Social dysfunction is a major feature of clinical-high-risk states for psychosis (CHR-P). Prior research has identified a neuroanatomical pattern associated with impaired social function outcome in CHR-P. The aim of the current study was to test whether social dysfunction in CHR-P is neurobiologically distinct or in a continuum with the lower end of the normal distribution of individual differences in social functioning. Methods We used a machine learning classifier to test for the presence of a previously validated brain structural pattern associated with impaired social outcome in CHR-P (CHR-outcome-neurosignature) in the neuroimaging profiles of individuals from two non-clinical samples (total n = 1763) and examined its association with social function, psychopathology and cognition. Results Although the CHR-outcome-neurosignature could be detected in a subset of the non-clinical samples, it was not associated was adverse social outcomes or higher psychopathology levels. However, participants whose neuroanatomical profiles were highly aligned with the CHR-outcome-neurosignature manifested subtle disadvantage in fluid (PFDR = 0.004) and crystallized intelligence (PFDR = 0.01), cognitive flexibility (PFDR = 0.02), inhibitory control (PFDR = 0.01), working memory (PFDR = 0.0005), and processing speed (PFDR = 0.04). Conclusions We provide evidence of divergence in brain structural underpinnings of social dysfunction derived from a psychosis-risk enriched population when applied to non-clinical samples. This approach appears promising in identifying brain mechanisms bound to psychosis through comparisons of patient populations to non-clinical samples with the same neuroanatomical profiles.
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Affiliation(s)
- Shalaila S. Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA
| | - Gaelle E. Doucet
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE 68010, USA
| | - Mathilde Antoniades
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia 19104, USA
| | - Amirhossein Modabbernia
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA
| | - René S. Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA
| | - Joseph Kambeitz
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany,Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstraße 7, 80336 München, Germany
| | - Stefan Borgwardt
- Department of Psychiatry, University Psychiatric Clinics (UPK), University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland,Department of Psychiatry, Psychosomatics and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck 23538, Germany
| | - Paolo Brambilla
- Department of Neuroscience and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milano, Italy,Department of Pathophysiology and Mental Health, University of Milan, Via Francesco Sforza 35, 20122 Milano, Italy
| | - Rachel Upthegrove
- Early Intervention Service, Birmingham Womens and Childrens NHS Trust, Steelhouse Lane, Birmingham, B4 6NH, UK,Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Stephen J. Wood
- Department of Pathophysiology and Mental Health, University of Milan, Via Francesco Sforza 35, 20122 Milano, Italy,Orygen, 35 Poplar Rd, Parkville, VIC 3052, Australia,Centre for Youth Mental Health, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Raimo K.R. Salokangas
- Department of Psychiatry, University of Turku and Turku University Hospital, FI-20014 Turun yliopisto, Finland
| | - Jarmo Hietala
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Moorenstrße 5, 40225 Düsseldorf, Germany
| | - Eva Meisenzahl
- Max-Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804 München, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstraße 7, 80336 München, Germany,Max-Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804 München, Germany,Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, SE5 8AF London, UK
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA,Department of Psychiatry, Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada,Corresponding author at: Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, NY, 10029, NY, USA.
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34
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Penzel N, Sanfelici R, Antonucci LA, Betz LT, Dwyer D, Ruef A, Cho KIK, Cumming P, Pogarell O, Howes O, Falkai P, Upthegrove R, Borgwardt S, Brambilla P, Lencer R, Meisenzahl E, Schultze-Lutter F, Rosen M, Lichtenstein T, Kambeitz-Ilankovic L, Ruhrmann S, Salokangas RKR, Pantelis C, Wood SJ, Quednow BB, Pergola G, Bertolino A, Koutsouleris N, Kambeitz J, Dwyer D, Ruef A, Kambeitz-Ilankovic L, Sen Dong M, Erkens A, Gussmann E, Haas S, Hasan A, Hoff C, Khanyaree I, Melo A, Muckenhuber-Sternbauer S, Kohler J, Ozturk OF, Popovic D, Rangnick A, von Saldern S, Sanfelici R, Spangemacher M, Tupac A, Urquijo MF, Weiske J, Wosgien A, Kambeitz J, Ruhrmann S, Rosen M, Betz L, Lichtenstein T, Blume K, Seves M, Kaiser N, Penzel N, Pilgram T, Lichtenstein T, Wenzel J, Woopen C, Borgwardt S, Andreou C, Egloff L, Harrisberger F, Lenz C, Leanza L, Mackintosh A, Smieskova R, Studerus E, Walter A, Widmayer S, Upthegrove R, Wood SJ, Chisholm K, Day C, Griffiths SL, Lalousis PA, Iqbal M, Pelton M, Mallikarjun P, Stainton A, Lin A, Salokangas RKR, Denissoff A, Ellila A, From T, Heinimaa M, Ilonen T, Jalo P, Laurikainen H, Lehtinen M, Luutonen A, Makela A, Paju J, Pesonen H, Armio Säilä RL, Sormunen E, Toivonen A, Turtonen O, Solana AB, Abraham M, Hehn N, Schirmer T, Brambilla P, Altamura C, Belleri M, Bottinelli F, Ferro A, Re M, Monzani E, Percudani M, Sberna M, D’Agostino A, Del Fabro L, Perna G, Nobile M, Alciati A, Balestrieri M, Bonivento C, Cabras G, Fabbro F, Garzitto M, PiCCuin S, Bertolino A, Blasi G, Antonucci LA, Pergola G, Caforio G, Faio L, Quarto T, Gelao B, Romano R, Andriola I, Falsetti A, Barone M, Passatiore R, Sangiuliano M, Lencer R, Surman M, Bienek O, Romer G, Dannlowski U, Meisenzahl E, Schultze-Lutter F, Schmidt-Kraepelin C, Neufang S, Korda A, Rohner H. Pattern of predictive features of continued cannabis use in patients with recent-onset psychosis and clinical high-risk for psychosis. Schizophrenia (Heidelb) 2022; 8:19. [PMID: 35264631 PMCID: PMC8907166 DOI: 10.1038/s41537-022-00218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/31/2022] [Indexed: 11/09/2022]
Abstract
Continued cannabis use (CCu) is an important predictor for poor long-term outcomes in psychosis and clinically high-risk patients, but no generalizable model has hitherto been tested for its ability to predict CCu in these vulnerable patient groups. In the current study, we investigated how structured clinical and cognitive assessments and structural magnetic resonance imaging (sMRI) contributed to the prediction of CCu in a group of 109 patients with recent-onset psychosis (ROP). We tested the generalizability of our predictors in 73 patients at clinical high-risk for psychosis (CHR). Here, CCu was defined as any cannabis consumption between baseline and 9-month follow-up, as assessed in structured interviews. All patients reported lifetime cannabis use at baseline. Data from clinical assessment alone correctly classified 73% (p < 0.001) of ROP and 59 % of CHR patients. The classifications of CCu based on sMRI and cognition were non-significant (ps > 0.093), and their addition to the interview-based predictor via stacking did not improve prediction significantly, either in the ROP or CHR groups (ps > 0.065). Lower functioning, specific substance use patterns, urbanicity and a lack of other coping strategies contributed reliably to the prediction of CCu and might thus represent important factors for guiding preventative efforts. Our results suggest that it may be possible to identify by clinical measures those psychosis-spectrum patients at high risk for CCu, potentially allowing to improve clinical care through targeted interventions. However, our model needs further testing in larger samples including more diverse clinical populations before being transferred into clinical practice.
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Affiliation(s)
- Nora Penzel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Education, Psychology, Communication, University of Bari, Bari, Italy
| | - Linda T Betz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Kang Ik K Cho
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul Cumming
- Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland.,School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia.,International Research Lab in Neuropsychiatry, Neuroscience Research Institute, Samara State Medical University, Samara, Russia
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK.,Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK.,South London and Maudsley NHS Foundation Trust, London, SE5 8AF, UK
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust, Birmingham, UK
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCUS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.,Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Otto Creutzfeldt Center for Behavioral and Cognitive Neuroscience, University of Münster, Münster, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marlene Rosen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Theresa Lichtenstein
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Stephan Ruhrmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstr. 31, 8032, Zurich, Switzerland
| | - Giulio Pergola
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany.,Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - Joseph Kambeitz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany.
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Antonucci LA, Penzel N, Sanfelici R, Pigoni A, Kambeitz-Ilankovic L, Dwyer D, Ruef A, Sen Dong M, Öztürk ÖF, Chisholm K, Haidl T, Rosen M, Ferro A, Pergola G, Andriola I, Blasi G, Ruhrmann S, Schultze-Lutter F, Falkai P, Kambeitz J, Lencer R, Dannlowski U, Upthegrove R, Salokangas RKR, Pantelis C, Meisenzahl E, Wood SJ, Brambilla P, Borgwardt S, Bertolino A, Koutsouleris N. Using combined environmental-clinical classification models to predict role functioning outcome in clinical high-risk states for psychosis and recent-onset depression. Br J Psychiatry 2022; 220:1-17. [PMID: 35152923 DOI: 10.1192/bjp.2022.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical high-risk states for psychosis (CHR) are associated with functional impairments and depressive disorders. A previous PRONIA study predicted social functioning in CHR and recent-onset depression (ROD) based on structural magnetic resonance imaging (sMRI) and clinical data. However, the combination of these domains did not lead to accurate role functioning prediction, calling for the investigation of additional risk dimensions. Role functioning may be more strongly associated with environmental adverse events than social functioning. AIMS We aimed to predict role functioning in CHR, ROD and transdiagnostically, by adding environmental adverse events-related variables to clinical and sMRI data domains within the PRONIA sample. METHOD Baseline clinical, environmental and sMRI data collected in 92 CHR and 95 ROD samples were trained to predict lower versus higher follow-up role functioning, using support vector classification and mixed k-fold/leave-site-out cross-validation. We built separate predictions for each domain, created multimodal predictions and validated them in independent cohorts (74 CHR, 66 ROD). RESULTS Models combining clinical and environmental data predicted role outcome in discovery and replication samples of CHR (balanced accuracies: 65.4% and 67.7%, respectively), ROD (balanced accuracies: 58.9% and 62.5%, respectively), and transdiagnostically (balanced accuracies: 62.4% and 68.2%, respectively). The most reliable environmental features for role outcome prediction were adult environmental adjustment, childhood trauma in CHR and childhood environmental adjustment in ROD. CONCLUSIONS Findings support the hypothesis that environmental variables inform role outcome prediction, highlight the existence of both transdiagnostic and syndrome-specific predictive environmental adverse events, and emphasise the importance of implementing real-world models by measuring multiple risk dimensions.
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Affiliation(s)
- Linda A Antonucci
- Department of Education Science, Psychology and Communication Science, University of Bari Aldo Moro, Italy; and Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany; and Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany; and Institute for Psychiatry, Max Planck School of Cognition, Germany
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; and Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, Italy
| | - Lana Kambeitz-Ilankovic
- Department of Education Science, Psychology and Communication Science, University of Bari Aldo Moro, Italy; and Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Mark Sen Dong
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Ömer Faruk Öztürk
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany; and Institute for Psychiatry, International Max Planck Research School for Translational Psychiatry, Germany
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, UK; and Department of Psychology, Aston University, UK
| | - Theresa Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Adele Ferro
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Italy
| | - Ileana Andriola
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Italy
| | - Giuseppe Blasi
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Italy
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University Düsseldorf, Germany; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Indonesia; and University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Münster, UK; and Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, UK; and Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, UK
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University Düsseldorf, Germany
| | - Stephen J Wood
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany; Orygen, Australia; Centre for Youth Mental Health, University of Melbourne, Australia; and School of Psychology, University of Birmingham, UK
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Stefan Borgwardt
- Institute for Translational Psychiatry, University of Münster, UK; and Department of Psychiatry (Psychiatric University Hospital, University Psychiatric Clinics Basel), University of Basel, Switzerland
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Germany
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Wen J, Varol E, Sotiras A, Yang Z, Chand GB, Erus G, Shou H, Abdulkadir A, Hwang G, Dwyer DB, Pigoni A, Dazzan P, Kahn RS, Schnack HG, Zanetti MV, Meisenzahl E, Busatto GF, Crespo-Facorro B, Rafael RG, Pantelis C, Wood SJ, Zhuo C, Shinohara RT, Fan Y, Gur RC, Gur RE, Satterthwaite TD, Koutsouleris N, Wolf DH, Davatzikos C. Multi-scale semi-supervised clustering of brain images: Deriving disease subtypes. Med Image Anal 2022; 75:102304. [PMID: 34818611 PMCID: PMC8678373 DOI: 10.1016/j.media.2021.102304] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/09/2021] [Accepted: 11/08/2021] [Indexed: 01/03/2023]
Abstract
Disease heterogeneity is a significant obstacle to understanding pathological processes and delivering precision diagnostics and treatment. Clustering methods have gained popularity for stratifying patients into subpopulations (i.e., subtypes) of brain diseases using imaging data. However, unsupervised clustering approaches are often confounded by anatomical and functional variations not related to a disease or pathology of interest. Semi-supervised clustering techniques have been proposed to overcome this and, therefore, capture disease-specific patterns more effectively. An additional limitation of both unsupervised and semi-supervised conventional machine learning methods is that they typically model, learn and infer from data using a basis of feature sets pre-defined at a fixed anatomical or functional scale (e.g., atlas-based regions of interest). Herein we propose a novel method, "Multi-scAle heteroGeneity analysIs and Clustering" (MAGIC), to depict the multi-scale presentation of disease heterogeneity, which builds on a previously proposed semi-supervised clustering method, HYDRA. It derives multi-scale and clinically interpretable feature representations and exploits a double-cyclic optimization procedure to effectively drive identification of inter-scale-consistent disease subtypes. More importantly, to understand the conditions under which the clustering model can estimate true heterogeneity related to diseases, we conducted extensive and systematic semi-simulated experiments to evaluate the proposed method on a sizeable healthy control sample from the UK Biobank (N = 4403). We then applied MAGIC to imaging data from Alzheimer's disease (ADNI, N = 1728) and schizophrenia (PHENOM, N = 1166) patients to demonstrate its potential and challenges in dissecting the neuroanatomical heterogeneity of common brain diseases. Taken together, we aim to provide guidance regarding when such analyses can succeed or should be taken with caution. The code of the proposed method is publicly available at https://github.com/anbai106/MAGIC.
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Affiliation(s)
- Junhao Wen
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | - Erdem Varol
- Department of Statistics, Center for Theoretical Neuroscience, Zuckerman Institute, Columbia University, New York, USA
| | - Aristeidis Sotiras
- Department of Radiology and Institute for Informatics, Washington University School of Medicine, St. Louis, USA
| | - Zhijian Yang
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ganesh B Chand
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, USA
| | - Guray Erus
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Haochang Shou
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ahmed Abdulkadir
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Gyujoon Hwang
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Dazzan
- Institute of Psychiatry, King's College London, London, UK
| | - Rene S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Hugo G Schnack
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcus V Zanetti
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Eva Meisenzahl
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Geraldo F Busatto
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Benedicto Crespo-Facorro
- Hospital Universitario Virgen del Rocio, University of Sevilla-IBIS; IDIVAL-CIBERSAM, Cantabria, Spain
| | - Romero-Garcia Rafael
- Department of Medical Physiology and Biophysics, University of Seville, Instituto de Investigación Sanitaria de Sevilla, IBiS, CIBERSAM, Sevilla, Spain
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Australia
| | - Stephen J Wood
- Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Australia
| | - Chuanjun Zhuo
- key Laboratory of Real Tine Tracing of Brain Circuits in Psychiatry and Neurology(RTBCPN-Lab), Nankai University Affiliated Tianjin Fourth Center Hospital; Department of Psychiatry, Tianjin Medical University, Tianjin, China
| | - Russell T Shinohara
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Yong Fan
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Theodore D Satterthwaite
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Daniel H Wolf
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
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Koll FJ, Meisenzahl E, Haller B, Maisch P, Kirchhoff F, Horn T, Gschwend JE, Schmid SC. Evaluation of Pre-operative Biopsy, Surgical Procedures and Oncologic Outcomes in Upper Tract Urothelial Carcinoma (UTUC). Front Surg 2021; 8:790738. [PMID: 34901146 PMCID: PMC8655158 DOI: 10.3389/fsurg.2021.790738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Discordance between pre-operative biopsy and final pathology for Upper Tract Urothelial Carcinoma (UTUC) is high and optimal management remains controversial. The aim of this study is to evaluate the accuracy of pre-operative biopsy, to identify prognostic factors and to evaluate the effect of adjuvant chemotherapy on survival and oncologic outcome in UTUC. Methods: We analyzed records of patients receiving surgical treatment for UTUC. Pathology of pre-operative biopsy was compared to surgical specimen. We used Kaplan-Meier method to estimate survival probabilities and Cox's proportional hazards models to estimate the association between covariates and event times. Primary endpoint was overall survival (OS). A matched-pair analysis was performed to evaluate the effect of adjuvant chemotherapy. Results: 151 patients underwent surgical treatment (28% open, 36% laparoscopic, 17% robotic radical nephroureterectomy; 14% segmental ureteral resections and 5% palliative nephrectomy) for UTUC and were included in the analysis. Upstaging from <pT1 in endoscopic biopsy to ≥pT1 in final pathology occurred in 61% of patients and upgrading from low-grade to high-grade occurred in 30% of patients. Five-year OS was 59.5%. In the univariate Cox-regression model pathological stage, grade, lymphovascular invasion and positive surgical margins were associated with OS. Matched pair analysis for stage (<pT3; ≥pT3; pN+) and age revealed a significant survival benefit for adjuvant chemotherapy (HR 0.40, 0.14-0.77, p < 0.018) in this cohort. Conclusion: UTUC is often underestimated in pre-operative biopsy, and it is associated with significant mortality. Pathological stage and grade, lymphovascular invasion and lymph node metastases are predictors of oncologic outcome and survival.
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Affiliation(s)
- Florestan J Koll
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, School of Medicine, Munich, Germany.,Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Eva Meisenzahl
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, School of Medicine, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Philipp Maisch
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, School of Medicine, Munich, Germany.,Department of Urology, University of Ulm, Ulm, Germany
| | - Florian Kirchhoff
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, School of Medicine, Munich, Germany
| | - Thomas Horn
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, School of Medicine, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sebastian C Schmid
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, School of Medicine, Munich, Germany
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Koll F, Meisenzahl E, Haller B, Maisch P, Kirchhhoff F, Horn T, Gschwend J, Schmid S. Evaluation of preoperative biopsy, prognostic factors and oncologic outcome in upper tract urothelial carcinoma (UTUC). EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Koutsouleris N, Worthington M, Dwyer DB, Kambeitz-Ilankovic L, Sanfelici R, Fusar-Poli P, Rosen M, Ruhrmann S, Anticevic A, Addington J, Perkins DO, Bearden CE, Cornblatt BA, Cadenhead KS, Mathalon DH, McGlashan T, Seidman L, Tsuang M, Walker EF, Woods SW, Falkai P, Lencer R, Bertolino A, Kambeitz J, Schultze-Lutter F, Meisenzahl E, Salokangas RKR, Hietala J, Brambilla P, Upthegrove R, Borgwardt S, Wood S, Gur RE, McGuire P, Cannon TD. Toward Generalizable and Transdiagnostic Tools for Psychosis Prediction: An Independent Validation and Improvement of the NAPLS-2 Risk Calculator in the Multisite PRONIA Cohort. Biol Psychiatry 2021; 90:632-642. [PMID: 34482951 PMCID: PMC8500930 DOI: 10.1016/j.biopsych.2021.06.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/03/2021] [Accepted: 06/27/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Transition to psychosis is among the most adverse outcomes of clinical high-risk (CHR) syndromes encompassing ultra-high risk (UHR) and basic symptom states. Clinical risk calculators may facilitate an early and individualized interception of psychosis, but their real-world implementation requires thorough validation across diverse risk populations, including young patients with depressive syndromes. METHODS We validated the previously described NAPLS-2 (North American Prodrome Longitudinal Study 2) calculator in 334 patients (26 with transition to psychosis) with CHR or recent-onset depression (ROD) drawn from the multisite European PRONIA (Personalised Prognostic Tools for Early Psychosis Management) study. Patients were categorized into three risk enrichment levels, ranging from UHR, over CHR, to a broad-risk population comprising patients with CHR or ROD (CHR|ROD). We assessed how risk enrichment and different predictive algorithms influenced prognostic performance using reciprocal external validation. RESULTS After calibration, the NAPLS-2 model predicted psychosis with a balanced accuracy (BAC) (sensitivity, specificity) of 68% (73%, 63%) in the PRONIA-UHR cohort, 67% (74%, 60%) in the CHR cohort, and 70% (73%, 66%) in patients with CHR|ROD. Multiple model derivation in PRONIA-CHR|ROD and validation in NAPLS-2-UHR patients confirmed that broader risk definitions produced more accurate risk calculators (CHR|ROD-based vs. UHR-based performance: 67% [68%, 66%] vs. 58% [61%, 56%]). Support vector machines were superior in CHR|ROD (BAC = 71%), while ridge logistic regression and support vector machines performed similarly in CHR (BAC = 67%) and UHR cohorts (BAC = 65%). Attenuated psychotic symptoms predicted psychosis across risk levels, while younger age and reduced processing speed became increasingly relevant for broader risk cohorts. CONCLUSIONS Clinical-neurocognitive machine learning models operating in young patients with affective and CHR syndromes facilitate a more precise and generalizable prediction of psychosis. Future studies should investigate their therapeutic utility in large-scale clinical trials.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Max-Planck Institute of Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom.
| | | | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Alan Anticevic
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | | | | | - Daniel H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, California; San Francisco VA Medical Center, San Francisco, California
| | - Thomas McGlashan
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Larry Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ming Tsuang
- University of California San Diego, San Diego, California
| | - Elaine F Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, Georgia
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Germany
| | | | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Rachel Upthegrove
- Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom; School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany; Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Stephen Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia; Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Philip McGuire
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut; Department of Psychiatry, Yale University, New Haven, Connecticut
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Rosen M, Betz LT, Kaiser N, Penzel N, Dwyer D, Lichtenstein TK, Schultze-Lutter F, Kambeitz-Ilankovic L, Bertolino A, Borgwardt S, Brambilla P, Lencer R, Meisenzahl E, Pantelis C, Salokangas RKR, Upthegrove R, Wood S, Ruhrmann S, Koutsouleris N, Kambeitz J. Detailed clinical phenotyping and generalisability in prognostic models of functioning in at-risk populations. Br J Psychiatry 2021; 220:1-4. [PMID: 35049486 DOI: 10.1192/bjp.2021.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Personalised prediction of functional outcomes is a promising approach for targeted early intervention in psychiatry. However, generalisability and resource efficiency of such prognostic models represent challenges. In the PRONIA study (German Clinical Trials Register: DRKS00005042), we demonstrate excellent generalisability of prognostic models in individuals at clinical high-risk for psychosis or with recent-onset depression, and substantial contributions of detailed clinical phenotyping, particularly to the prediction of role functioning. These results indicate that it is possible that functioning prediction models based only on clinical data could be effectively applied in diverse healthcare settings, so that neuroimaging data may not be needed at early assessment stages.
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Affiliation(s)
- Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Linda T Betz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Natalie Kaiser
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany; and Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Theresa K Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; and University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; and University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany; and Department of Psychiatry, University of Münster, Münster, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, Australia
| | | | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK; and Early Intervention Service, Birmingham Womens and Childrens NHS trust, Birmingham, UK
| | - Stephen Wood
- School of Psychology, University of Birmingham, UK; and Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; and Max-Planck Institute of Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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41
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Sanfelici R, Ruef A, Antonucci LA, Penzel N, Sotiras A, Dong MS, Urquijo-Castro M, Wenzel J, Kambeitz-Ilankovic L, Hettwer MD, Ruhrmann S, Chisholm K, Riecher-Rössler A, Falkai P, Pantelis C, Salokangas RKR, Lencer R, Bertolino A, Kambeitz J, Meisenzahl E, Borgwardt S, Brambilla P, Wood SJ, Upthegrove R, Schultze-Lutter F, Koutsouleris N, Dwyer DB. Novel Gyrification Networks Reveal Links with Psychiatric Risk Factors in Early Illness. Cereb Cortex 2021; 32:1625-1636. [PMID: 34519351 DOI: 10.1093/cercor/bhab288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
Adult gyrification provides a window into coordinated early neurodevelopment when disruptions predispose individuals to psychiatric illness. We hypothesized that the echoes of such disruptions should be observed within structural gyrification networks in early psychiatric illness that would demonstrate associations with developmentally relevant variables rather than specific psychiatric symptoms. We employed a new data-driven method (Orthogonal Projective Non-Negative Matrix Factorization) to delineate novel gyrification-based networks of structural covariance in 308 healthy controls. Gyrification within the networks was then compared to 713 patients with recent onset psychosis or depression, and at clinical high-risk. Associations with diagnosis, symptoms, cognition, and functioning were investigated using linear models. Results demonstrated 18 novel gyrification networks in controls as verified by internal and external validation. Gyrification was reduced in patients in temporal-insular, lateral occipital, and lateral fronto-parietal networks (pFDR < 0.01) and was not moderated by illness group. Higher gyrification was associated with better cognitive performance and lifetime role functioning, but not with symptoms. The findings demonstrated that gyrification can be parsed into novel brain networks that highlight generalized illness effects linked to developmental vulnerability. When combined, our study widens the window into the etiology of psychiatric risk and its expression in adulthood.
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Affiliation(s)
- Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany.,Max Planck School of Cognition, Leipzig, 04103, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany
| | - Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany.,Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, 70124, Italy
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany
| | - Aristeidis Sotiras
- Department of Radiology and Institute of Informatics, Washington University in St. Luis, st. Luis, MO63110, USA
| | - Mark Sen Dong
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany
| | - Maria Urquijo-Castro
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Psychology, Aston University, Birmingham, B4 7ET, UK
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany.,Max-Planck Institute of Psychiatry, Munich, 80804, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centrem University of Melbourne & Melbourne Health, Melbourne, 3053, Australia
| | | | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, 48149, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, 23538, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, 70124, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, 40629, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, 23538, Germany.,Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, 4002, Switzerland
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milano, 20122, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, 20122, Italy
| | - Stephen J Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, 3052, Australia.,Orygen, Melbourne, 3052, Australia.,School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK.,Early Intervention Service, Birmingham Women's and Children's NHS foundation Trust, Birmingham, B4 6NH, UK
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, 40629, Germany.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surubaya, 60286, Indonesia.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, 3000, Switzerland
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany.,Max-Planck Institute of Psychiatry, Munich, 80804, Germany.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany
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Haas SS, Antonucci LA, Wenzel J, Ruef A, Biagianti B, Paolini M, Rauchmann BS, Weiske J, Kambeitz J, Borgwardt S, Brambilla P, Meisenzahl E, Salokangas RKR, Upthegrove R, Wood SJ, Koutsouleris N, Kambeitz-Ilankovic L. A multivariate neuromonitoring approach to neuroplasticity-based computerized cognitive training in recent onset psychosis. Neuropsychopharmacology 2021; 46:828-835. [PMID: 33027802 PMCID: PMC8027389 DOI: 10.1038/s41386-020-00877-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
Two decades of studies suggest that computerized cognitive training (CCT) has an effect on cognitive improvement and the restoration of brain activity. Nevertheless, individual response to CCT remains heterogenous, and the predictive potential of neuroimaging in gauging response to CCT remains unknown. We employed multivariate pattern analysis (MVPA) on whole-brain resting-state functional connectivity (rsFC) to (neuro)monitor clinical outcome defined as psychosis-likeness change after 10-hours of CCT in recent onset psychosis (ROP) patients. Additionally, we investigated if sensory processing (SP) change during CCT is associated with individual psychosis-likeness change and cognitive gains after CCT. 26 ROP patients were divided into maintainers and improvers based on their SP change during CCT. A support vector machine (SVM) classifier separating 56 healthy controls (HC) from 35 ROP patients using rsFC (balanced accuracy of 65.5%, P < 0.01) was built in an independent sample to create a naturalistic model representing the HC-ROP hyperplane. This model was out-of-sample cross-validated in the ROP patients from the CCT trial to assess associations between rsFC pattern change, cognitive gains and SP during CCT. Patients with intact SP threshold at baseline showed improved attention despite psychosis status on the SVM hyperplane at follow-up (p < 0.05). Contrarily, the attentional gains occurred in the ROP patients who showed impaired SP at baseline only if rsfMRI diagnosis status shifted to the healthy-like side of the SVM continuum. Our results reveal the utility of MVPA for elucidating treatment response neuromarkers based on rsFC-SP change and pave the road to more personalized interventions.
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Affiliation(s)
- Shalaila S. Haas
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Linda A. Antonucci
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany ,grid.7644.10000 0001 0120 3326Department of Education, Psychology, Communication – University of Bari “Aldo Moro”, Bari, Italy
| | - Julian Wenzel
- grid.6190.e0000 0000 8580 3777University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Anne Ruef
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Bruno Biagianti
- grid.438587.50000 0004 0450 1574Department of R&D, Posit Science Corporation, San Francisco, CA USA ,grid.4708.b0000 0004 1757 2822Department of Pathophysiology and Transplantation, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Marco Paolini
- Department of Radiology, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Boris-Stephan Rauchmann
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany ,Department of Radiology, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Johanna Weiske
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Joseph Kambeitz
- grid.6190.e0000 0000 8580 3777University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Stefan Borgwardt
- grid.4562.50000 0001 0057 2672Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Paolo Brambilla
- grid.414818.00000 0004 1757 8749Department of Neuroscience and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - Eva Meisenzahl
- grid.411327.20000 0001 2176 9917Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Raimo K. R. Salokangas
- grid.1374.10000 0001 2097 1371Department of Psychiatry, University of Turku, Turku, Finland
| | - Rachel Upthegrove
- grid.6572.60000 0004 1936 7486School of Psychology, University of Birmingham, Birmingham, United Kingdom ,grid.6572.60000 0004 1936 7486Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Stephen J. Wood
- grid.6572.60000 0004 1936 7486School of Psychology, University of Birmingham, Birmingham, United Kingdom ,grid.488501.0Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, VIC Australia
| | - Nikolaos Koutsouleris
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany. .,University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
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Rosen M, Betz LT, Schultze-Lutter F, Chisholm K, Haidl TK, Kambeitz-Ilankovic L, Bertolino A, Borgwardt S, Brambilla P, Lencer R, Meisenzahl E, Ruhrmann S, Salokangas RKR, Upthegrove R, Wood SJ, Koutsouleris N, Kambeitz J. Towards clinical application of prediction models for transition to psychosis: A systematic review and external validation study in the PRONIA sample. Neurosci Biobehav Rev 2021; 125:478-492. [PMID: 33636198 DOI: 10.1016/j.neubiorev.2021.02.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/14/2021] [Accepted: 02/20/2021] [Indexed: 01/13/2023]
Abstract
A multitude of prediction models for a first psychotic episode in individuals at clinical high-risk (CHR) for psychosis have been proposed, but only rarely validated. We identified transition models based on clinical and neuropsychological data through a registered systematic literature search and evaluated their external validity in 173 CHRs from the Personalised Prognostic Tools for Early Psychosis Management (PRONIA) study. Discrimination performance was assessed with the area under the receiver operating characteristic curve (AUC), and compared to the prediction of clinical raters. External discrimination performance varied considerably across the 22 identified models (AUC 0.40-0.76), with two models showing good discrimination performance. None of the tested models significantly outperformed clinical raters (AUC = 0.75). Combining predictions of clinical raters and the best model descriptively improved discrimination performance (AUC = 0.84). Results show that personalized prediction of transition in CHR is potentially feasible on a global scale. For implementation in clinical practice, further rounds of external validation, impact studies, and development of an ethical framework is necessary.
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Affiliation(s)
- Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Linda T Betz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katharine Chisholm
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK; Department of Psychology, Aston University, Birmingham, UK
| | - Theresa K Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany; Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany; Department of Psychiatry, University of Münster, Münster, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Stephen J Wood
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK; Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; Max-Planck Institute of Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
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44
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Lalousis PA, Wood SJ, Schmaal L, Chisholm K, Griffiths SL, Reniers RLEP, Bertolino A, Borgwardt S, Brambilla P, Kambeitz J, Lencer R, Pantelis C, Ruhrmann S, Salokangas RKR, Schultze-Lutter F, Bonivento C, Dwyer D, Ferro A, Haidl T, Rosen M, Schmidt A, Meisenzahl E, Koutsouleris N, Upthegrove R. Heterogeneity and Classification of Recent Onset Psychosis and Depression: A Multimodal Machine Learning Approach. Schizophr Bull 2021; 47:1130-1140. [PMID: 33543752 PMCID: PMC8266654 DOI: 10.1093/schbul/sbaa185] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Diagnostic heterogeneity within and across psychotic and affective disorders challenges accurate treatment selection, particularly in the early stages. Delineation of shared and distinct illness features at the phenotypic and brain levels may inform the development of more precise differential diagnostic tools. We aimed to identify prototypes of depression and psychosis to investigate their heterogeneity, with common, comorbid transdiagnostic symptoms. Analyzing clinical/neurocognitive and grey matter volume (GMV) data from the PRONIA database, we generated prototypic models of recent-onset depression (ROD) vs. recent-onset psychosis (ROP) by training support-vector machines to separate patients with ROD from patients with ROP, who were selected for absent comorbid features (pure groups). Then, models were applied to patients with comorbidity, ie, ROP with depressive symptoms (ROP+D) and ROD participants with sub-threshold psychosis-like features (ROD+P), to measure their positions within the affective-psychotic continuum. All models were independently validated in a replication sample. Comorbid patients were positioned between pure groups, with ROP+D patients being more frequently classified as ROD compared to pure ROP patients (clinical/neurocognitive model: χ2 = 14.874; P < .001; GMV model: χ2 = 4.933; P = .026). ROD+P patient classification did not differ from ROD (clinical/neurocognitive model: χ2 = 1.956; P = 0.162; GMV model: χ2 = 0.005; P = .943). Clinical/neurocognitive and neuroanatomical models demonstrated separability of prototypic depression from psychosis. The shift of comorbid patients toward the depression prototype, observed at the clinical and biological levels, suggests that psychosis with affective comorbidity aligns more strongly to depressive rather than psychotic disease processes. Future studies should assess how these quantitative measures of comorbidity predict outcomes and individual responses to stratified therapeutic interventions.
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Affiliation(s)
- Paris Alexandros Lalousis
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- To whom correspondence should be addressed; 52 Pritchatts Road, B15 2SA, Birmingham, UK; e-mail:
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Department of Psychology, Aston University, Birmingham, UK
| | - Sian Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Renate L E P Reniers
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland
- Department of Psychiatry and Psychotherapy, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Neurosciences and Mental Health, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Ludwig Maxmilians University, Munich, Germany
| | - Rebekka Lencer
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carolina Bonivento
- IRCCS “E. Medea” Scientific Institute, San Vito al Tagliamento (Pn), Italy
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig Maxmilians University, Munich, Germany
| | - Adele Ferro
- Department of Neurosciences and Mental Health, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Theresa Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Andre Schmidt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maxmilians University, Munich, Germany
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- Early Intervention Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
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Koutsouleris N, Dwyer DB, Degenhardt F, Maj C, Urquijo-Castro MF, Sanfelici R, Popovic D, Oeztuerk O, Haas SS, Weiske J, Ruef A, Kambeitz-Ilankovic L, Antonucci LA, Neufang S, Schmidt-Kraepelin C, Ruhrmann S, Penzel N, Kambeitz J, Haidl TK, Rosen M, Chisholm K, Riecher-Rössler A, Egloff L, Schmidt A, Andreou C, Hietala J, Schirmer T, Romer G, Walger P, Franscini M, Traber-Walker N, Schimmelmann BG, Flückiger R, Michel C, Rössler W, Borisov O, Krawitz PM, Heekeren K, Buechler R, Pantelis C, Falkai P, Salokangas RKR, Lencer R, Bertolino A, Borgwardt S, Noethen M, Brambilla P, Wood SJ, Upthegrove R, Schultze-Lutter F, Theodoridou A, Meisenzahl E. Multimodal Machine Learning Workflows for Prediction of Psychosis in Patients With Clinical High-Risk Syndromes and Recent-Onset Depression. JAMA Psychiatry 2021; 78:195-209. [PMID: 33263726 PMCID: PMC7711566 DOI: 10.1001/jamapsychiatry.2020.3604] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Diverse models have been developed to predict psychosis in patients with clinical high-risk (CHR) states. Whether prediction can be improved by efficiently combining clinical and biological models and by broadening the risk spectrum to young patients with depressive syndromes remains unclear. OBJECTIVES To evaluate whether psychosis transition can be predicted in patients with CHR or recent-onset depression (ROD) using multimodal machine learning that optimally integrates clinical and neurocognitive data, structural magnetic resonance imaging (sMRI), and polygenic risk scores (PRS) for schizophrenia; to assess models' geographic generalizability; to test and integrate clinicians' predictions; and to maximize clinical utility by building a sequential prognostic system. DESIGN, SETTING, AND PARTICIPANTS This multisite, longitudinal prognostic study performed in 7 academic early recognition services in 5 European countries followed up patients with CHR syndromes or ROD and healthy volunteers. The referred sample of 167 patients with CHR syndromes and 167 with ROD was recruited from February 1, 2014, to May 31, 2017, of whom 26 (23 with CHR syndromes and 3 with ROD) developed psychosis. Patients with 18-month follow-up (n = 246) were used for model training and leave-one-site-out cross-validation. The remaining 88 patients with nontransition served as the validation of model specificity. Three hundred thirty-four healthy volunteers provided a normative sample for prognostic signature evaluation. Three independent Swiss projects contributed a further 45 cases with psychosis transition and 600 with nontransition for the external validation of clinical-neurocognitive, sMRI-based, and combined models. Data were analyzed from January 1, 2019, to March 31, 2020. MAIN OUTCOMES AND MEASURES Accuracy and generalizability of prognostic systems. RESULTS A total of 668 individuals (334 patients and 334 controls) were included in the analysis (mean [SD] age, 25.1 [5.8] years; 354 [53.0%] female and 314 [47.0%] male). Clinicians attained a balanced accuracy of 73.2% by effectively ruling out (specificity, 84.9%) but ineffectively ruling in (sensitivity, 61.5%) psychosis transition. In contrast, algorithms showed high sensitivity (76.0%-88.0%) but low specificity (53.5%-66.8%). A cybernetic risk calculator combining all algorithmic and human components predicted psychosis with a balanced accuracy of 85.5% (sensitivity, 84.6%; specificity, 86.4%). In comparison, an optimal prognostic workflow produced a balanced accuracy of 85.9% (sensitivity, 84.6%; specificity, 87.3%) at a much lower diagnostic burden by sequentially integrating clinical-neurocognitive, expert-based, PRS-based, and sMRI-based risk estimates as needed for the given patient. Findings were supported by good external validation results. CONCLUSIONS AND RELEVANCE These findings suggest that psychosis transition can be predicted in a broader risk spectrum by sequentially integrating algorithms' and clinicians' risk estimates. For clinical translation, the proposed workflow should undergo large-scale international validation.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,Max-Planck Institute of Psychiatry, Munich, Germany,Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Dominic B. Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carlo Maj
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | | | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,Max-Planck School of Cognition, Leipzig, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Oemer Oeztuerk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Shalaila S. Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johanna Weiske
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Linda A. Antonucci
- Department of Education, Psychology, and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Theresa K. Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Anita Riecher-Rössler
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - Laura Egloff
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - André Schmidt
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - Christina Andreou
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Timo Schirmer
- GE Healthcare GmbH (previously GE Global Research GmbH), Munich, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University of Münster, Münster, Germany
| | - Petra Walger
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, LVR Clinic Düsseldorf, Düsseldorf, Germany
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Benno G. Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Oleg Borisov
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Peter M. Krawitz
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland,Department of Psychiatry and Psychotherapy I, LVR Hospital Cologne, Cologne, Germany
| | - Roman Buechler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland,Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,Max-Planck Institute of Psychiatry, Munich, Germany
| | | | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Markus Noethen
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stephen J. Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia,Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Australia
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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Betz LT, Penzel N, Kambeitz-Ilankovic L, Rosen M, Chisholm K, Stainton A, Haidl TK, Wenzel J, Bertolino A, Borgwardt S, Brambilla P, Lencer R, Meisenzahl E, Ruhrmann S, Salokangas RKR, Schultze-Lutter F, Wood SJ, Upthegrove R, Koutsouleris N, Kambeitz J. General psychopathology links burden of recent life events and psychotic symptoms in a network approach. NPJ Schizophr 2020; 6:40. [PMID: 33319805 PMCID: PMC7738498 DOI: 10.1038/s41537-020-00129-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
Recent life events have been implicated in the onset and progression of psychosis. However, psychological processes that account for the association are yet to be fully understood. Using a network approach, we aimed to identify pathways linking recent life events and symptoms observed in psychosis. Based on previous literature, we hypothesized that general symptoms would mediate between recent life events and psychotic symptoms. We analyzed baseline data of patients at clinical high risk for psychosis and with recent-onset psychosis (n = 547) from the Personalised Prognostic Tools for Early Psychosis Management (PRONIA) study. In a network analysis, we modeled links between the burden of recent life events and all individual symptoms of the Positive and Negative Syndrome Scale before and after controlling for childhood trauma. To investigate the longitudinal associations between burden of recent life events and symptoms, we analyzed multiwave panel data from seven timepoints up to month 18. Corroborating our hypothesis, burden of recent life events was connected to positive and negative symptoms through general psychopathology, specifically depression, guilt feelings, anxiety and tension, even after controlling for childhood trauma. Longitudinal modeling indicated that on average, burden of recent life events preceded general psychopathology in the individual. In line with the theory of an affective pathway to psychosis, recent life events may lead to psychotic symptoms via heightened emotional distress. Life events may be one driving force of unspecific, general psychopathology described as characteristic of early phases of the psychosis spectrum, offering promising avenues for interventions.
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Affiliation(s)
- Linda T Betz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Department of Psychology, Aston University, Birmingham, UK
| | - Alexandra Stainton
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Theresa K Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Department of Psychiatry, University of Münster, Münster, Germany
- Otto Creutzfeldt Center for Behavioral and Cognitive Neuroscience, University of Münster, Münster, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | | | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck Institute of Psychiatry, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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Abstract
Psychotic disorders in ICD-11: the revisions Abstract. This article provides an overview of the main changes to the chapter "Schizophrenia or Other Primary Psychotic Disorders" (6A2) from ICD-10 to ICD-11 and compares them with the psychosis chapter of DSM-5. These changes include abandoning the classical subtypes of Schizophrenia as well as of the special significance of Schneider's first-rank symptoms, resulting in the general requirement of two key features (one must be a positive symptom) in the definition of "Schizophrenia" (6A20) and the allowance for bizarre contents in "Delusional Disorder" (6A24), which now includes "Induced Delusional Disorder" (F24). Further introduced are the focus on the current episode, the restriction of "Acute and Transient Psychotic Disorder" (6A23) to the former Polymorphic Disorder Without Schizophrenic Symptoms (F23.0), the diagnosis of delusional "Obsessive-Compulsive or Related Disorders" (6B2) exclusively as Obsessive-Compulsive Disorders, the specification of "Schizoaffective Disorder" (6A21), and the formulation of a distinct subchapter "Catatonia" (6A4) for the assessment of catatonic features in the context of several disorders. In analogy to DSM-5, ICD-11 now includes the optional category "Symptomatic Manifestations of Primary Psychotic Disorders" (6A25) for the dimensional quantification of symptoms. Again, developmental aspects remain unattended in in the ICD-11-definitions of psychotic disorders.
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Affiliation(s)
- Frauke Schultze-Lutter
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.,Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Eva Meisenzahl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Chantal Michel
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz
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Popovic D, Ruef A, Dwyer DB, Antonucci LA, Eder J, Sanfelici R, Kambeitz-Ilankovic L, Oztuerk OF, Dong MS, Paul R, Paolini M, Hedderich D, Haidl T, Kambeitz J, Ruhrmann S, Chisholm K, Schultze-Lutter F, Falkai P, Pergola G, Blasi G, Bertolino A, Lencer R, Dannlowski U, Upthegrove R, Salokangas RKR, Pantelis C, Meisenzahl E, Wood SJ, Brambilla P, Borgwardt S, Koutsouleris N. Traces of Trauma: A Multivariate Pattern Analysis of Childhood Trauma, Brain Structure, and Clinical Phenotypes. Biol Psychiatry 2020; 88:829-842. [PMID: 32782139 DOI: 10.1016/j.biopsych.2020.05.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Childhood trauma (CT) is a major yet elusive psychiatric risk factor, whose multidimensional conceptualization and heterogeneous effects on brain morphology might demand advanced mathematical modeling. Therefore, we present an unsupervised machine learning approach to characterize the clinical and neuroanatomical complexity of CT in a larger, transdiagnostic context. METHODS We used a multicenter European cohort of 1076 female and male individuals (discovery: n = 649; replication: n = 427) comprising young, minimally medicated patients with clinical high-risk states for psychosis; patients with recent-onset depression or psychosis; and healthy volunteers. We employed multivariate sparse partial least squares analysis to detect parsimonious associations between combinations of items from the Childhood Trauma Questionnaire and gray matter volume and tested their generalizability via nested cross-validation as well as via external validation. We investigated the associations of these CT signatures with state (functioning, depressivity, quality of life), trait (personality), and sociodemographic levels. RESULTS We discovered signatures of age-dependent sexual abuse and sex-dependent physical and sexual abuse, as well as emotional trauma, which projected onto gray matter volume patterns in prefronto-cerebellar, limbic, and sensory networks. These signatures were associated with predominantly impaired clinical state- and trait-level phenotypes, while pointing toward an interaction between sexual abuse, age, urbanicity, and education. We validated the clinical profiles for all three CT signatures in the replication sample. CONCLUSIONS Our results suggest distinct multilayered associations between partially age- and sex-dependent patterns of CT, distributed neuroanatomical networks, and clinical profiles. Hence, our study highlights how machine learning approaches can shape future, more fine-grained CT research.
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Affiliation(s)
- David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Max Planck Society, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany; Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Julia Eder
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany; Max Planck School of Cognition, Max Planck Schools, Leipzig, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Omer Faruk Oztuerk
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Max Planck Society, Munich, Germany
| | - Mark S Dong
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Riya Paul
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany; Max Planck Institute of Psychiatry, Max Planck Schools, Munich, Germany
| | - Marco Paolini
- Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Dennis Hedderich
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
| | - Theresa Haidl
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Katharine Chisholm
- School of Psychology, University of Birmingham, Birmingham, United Kingdom; Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Giulio Pergola
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Blasi
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, Birmingham, United Kingdom; Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia; Melbourne Health, Carlton South, Victoria, Australia
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stephen J Wood
- School of Psychology, University of Birmingham, Birmingham, United Kingdom; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefan Borgwardt
- Neuropsychiatry and Brain Imaging Group, Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Max Planck Society, Munich, Germany.
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Jimeno N, Gomez-Pilar J, Poza J, Hornero R, Vogeley K, Meisenzahl E, Haidl T, Rosen M, Klosterkötter J, Schultze-Lutter F. Main Symptomatic Treatment Targets in Suspected and Early Psychosis: New Insights From Network Analysis. Schizophr Bull 2020; 46:884-895. [PMID: 32010940 PMCID: PMC7345824 DOI: 10.1093/schbul/sbz140] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The early detection and intervention in psychoses prior to their first episode are presently based on the symptomatic ultra-high-risk and the basic symptom criteria. Current models of symptom development assume that basic symptoms develop first, followed by attenuated and, finally, frank psychotic symptoms, though interrelations of these symptoms are yet unknown. Therefore, we studied for the first time their interrelations using a network approach in 460 patients of an early detection service (mean age = 26.3 y, SD = 6.4; 65% male; n = 203 clinical high-risk [CHR], n = 153 first-episode psychosis, and n = 104 depression). Basic, attenuated, and frank psychotic symptoms were assessed using the Schizophrenia Proneness Instrument, Adult version (SPI-A), the Structured Interview for Psychosis-Risk Syndromes (SIPS), and the Positive And Negative Syndrome Scale (PANSS). Using the R package qgraph, network analysis of the altogether 86 symptoms revealed a single dense network of highly interrelated symptoms with 5 discernible symptom subgroups. Disorganized communication was the most central symptom, followed by delusions and hallucinations. In line with current models of symptom development, the network was distinguished by symptom severity running from SPI-A via SIPS to PANSS assessments. This suggests that positive symptoms developed from cognitive and perceptual disturbances included basic symptom criteria. Possibly conveying important insight for clinical practice, central symptoms, and symptoms "bridging" the association between symptom subgroups may be regarded as the main treatment targets, in order to prevent symptomatology from spreading or increasing across the whole network.
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Affiliation(s)
- Natalia Jimeno
- Department of Psychiatry, School of Medicine University of Valladolid, Valladolid, Spain
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Düsseldorf, Germany
- GINCS, Research Group on Clinical Neuroscience of Segovia, Segovia, Spain
| | - Javier Gomez-Pilar
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigacion Biomedica en Red-Bioingenieria, Biomateriales y Biomedicina, Valladolid, Spain
| | - Jesus Poza
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigacion Biomedica en Red-Bioingenieria, Biomateriales y Biomedicina, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigacion Biomedica en Red-Bioingenieria, Biomateriales y Biomedicina, Valladolid, Spain
| | - Kai Vogeley
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
- INM3, Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Düsseldorf, Germany
| | - Theresa Haidl
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
| | - Joachim Klosterkötter
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Düsseldorf, Germany
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Upthegrove R, Lalousis P, Mallikarjun P, Chisholm K, Griffiths SL, Iqbal M, Pelton M, Reniers R, Stainton A, Rosen M, Ruef A, Dwyer DB, Surman M, Haidl T, Penzel N, Kambeitz-llankovic L, Bertolino A, Brambilla P, Borgwardt S, Kambeitz J, Lencer R, Pantelis C, Ruhrmann S, Schultze-Lutter F, Salokangas RKR, Meisenzahl E, Wood SJ, Koutsouleris N. The Psychopathology and Neuroanatomical Markers of Depression in Early Psychosis. Schizophr Bull 2020; 47:249-258. [PMID: 32634220 PMCID: PMC7825071 DOI: 10.1093/schbul/sbaa094] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Depression frequently occurs in first-episode psychosis (FEP) and predicts longer-term negative outcomes. It is possible that this depression is seen primarily in a distinct subgroup, which if identified could allow targeted treatments. We hypothesize that patients with recent-onset psychosis (ROP) and comorbid depression would be identifiable by symptoms and neuroanatomical features similar to those seen in recent-onset depression (ROD). Data were extracted from the multisite PRONIA study: 154 ROP patients (FEP within 3 months of treatment onset), of whom 83 were depressed (ROP+D) and 71 who were not depressed (ROP-D), 146 ROD patients, and 265 healthy controls (HC). Analyses included a (1) principal component analysis that established the similar symptom structure of depression in ROD and ROP+D, (2) supervised machine learning (ML) classification with repeated nested cross-validation based on depressive symptoms separating ROD vs ROP+D, which achieved a balanced accuracy (BAC) of 51%, and (3) neuroanatomical ML-based classification, using regions of interest generated from ROD subjects, which identified BAC of 50% (no better than chance) for separation of ROP+D vs ROP-D. We conclude that depression at a symptom level is broadly similar with or without psychosis status in recent-onset disorders; however, this is not driven by a separable depressed subgroup in FEP. Depression may be intrinsic to early stages of psychotic disorder, and thus treating depression could produce widespread benefit.
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Affiliation(s)
- Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK,To whom correspondence should be addressed; Institute for Mental Health, University of Birmingham, 52 Prichatts Road, Edgbaston, Birmingham B152TT, UK; tel: +44-(0)121-414-4932, fax:+44-(0)121-414-4897, e-mail:
| | - Paris Lalousis
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Pavan Mallikarjun
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Katharine Chisholm
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK,Department of Psychology, Aston University, Birmingham, UK
| | - Sian Lowri Griffiths
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Mariam Iqbal
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Mirabel Pelton
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Renate Reniers
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK,Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alexandra Stainton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Marian Surman
- Department of Mental Health, University of Münster, Münster, Germany
| | - Theresa Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-llankovic
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari “Aldo Moro,” Bari, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Rebekka Lencer
- Department of Mental Health, University of Münster, Münster, Germany,Department of Psychiatry and Psychotherapy, University Lübeck, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephen J Wood
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK,Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
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